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Background: The prevalence of low birth weight (LBW) has stagnated at approximately 12% for the past 15 years in Nepal, significantly impacting newborn survival. While antenatal care (ANC) visits and iron-folic acid supplementation are recognised as important interventions to reduce LBW, there is a lack of evidence regarding their combined effect. This study aimed to explore the potential synergistic impact of ANC and iron-folic acid supplementation on LBW in Nepal by analyzing data from two national surveys. Methods: The nationally representative Nepal Demographic and Health Surveys of 2016 and 2022 were used, and the pooled dataset was analysed. Birth weight and the prevalence of LBW (i.e. birthweight < 2500 g) were reported using descriptive statistics. The associations among LBW, ANC visits, and iron-folic acid supplementation were examined using logistic regression analyses. Results: The mean birth weight was 3011 g, with an LBW prevalence of 11.2%. Not attending ANC (Adjusted Odds Ratio (AOR): 1.49; 95% Confidence Interval (CI): 1.14, 1.95) and not consuming iron-folic acid supplements (AOR: 1.43; 95% CI: 1.11, 1.84) were independently associated with a higher likelihood of having LBW. Furthermore, when considering both factors together, mothers who attended less than four ANC visits and consumed iron-folic acid for ≤ 90 days had the higher likelihood of having LBW (AOR: 1.99; 95% CI: 1.35, 2.60) compared to those who did not. Conclusions: This study highlights that the individual and joint influence of ANC visits and iron-folic acid supplementation on having LBW. These findings underscore the significance of ANC attendance and iron-folic acid supplementation in preventing LBW. Traditionally, these two interventions were primarily considered as maternal survival strategies. However, our findings indicate that these existing interventions could be utilised further for both maternal and newborn survival. Given that these services are offered free of cost and are available near people's homes through the National Safe Motherhood Programme in Nepal, efforts to increase the uptake of these services should be strengthened while emphasising their role in preventing LBW. [ABSTRACT FROM AUTHOR]

Background: Over the past two decades, antenatal care (ANC) coverage has increased in most settings across low- and middle-income countries, including Ghana. However, evidence shows that there is a need to focus on both access and quality to improve maternal and newborn health outcomes. We investigated ANC quality among public healthcare facilities in the northern region of Ghana. Methods: We conducted a facility-based study involving 420 postpartum women, selected randomly from five public health facilities. We collected information on a set of prenatal services that respondents self-reported to have received during their most recent pregnancy. Women who received all the interventions assessed were considered to have received quality ANC. Using multilevel (mixed-effects) regression analysis, we identified the independent factors associated with ANC quality, with healthcare facility as the cluster variable. Results: Of the 420 women, 31.2% (95% CI: 26.9, 35.8) received ANC services of high quality. ANC quality differed significantly by women's background characteristics and ANC use. However, gestational age at first ANC and the number of follow-up visits before delivery were significantly associated with ANC quality: booking the first visit in the second or third trimester reduced the odds of receiving high-quality ANC compared to booking in the first trimester (aOR = 0.15, 95% CI: 0.07, 0.31, and aOR = 0.09, 95% CI: 0.01, 0.83, respectively). In contrast, achieving a minimum of eight ANC follow-ups before delivery increased the odds of receiving high-quality ANC compared to attaining fewer than eight visits (aOR = 4.82, 95% CI: 2.33, 9.99). Conclusions: A significant proportion of pregnant women in the study setting received suboptimal quality ANC during their most recent pregnancy. ANC quality was primarily associated with the timing of the first visit and the number of follow-up visits before delivery. Timely initiation of ANC and frequent follow-up visits will be crucial in the study's setting for pregnant women to benefit from comprehensive ANC services. [ABSTRACT FROM AUTHOR]

Introduction: Between 2006 and 2017, antenatal care (ANC) coverage in Benin declined, potentially exacerbating inequalities and substantiating the need for health inequality monitoring. This study examines inequalities in ANC attendance in Benin, disaggregated by women's age, educational level, economic status, place of residence, region of residence, and the extent to which they have changed over time. Methods: Three rounds of the Benin Demographic and Health Surveys (2006, 2011–12, and 2017–18) were analyzed to examine inequalities in ANC coverage. An exploratory descriptive approach was adopted for the analysis. Simple [difference (D) and ratio (R)] and complex [population attributable risk (PAR) and population attributable fraction (PAF)] measures of inequalities were computed using the World Health Organization's Health Equity Assessment Toolkit (WHO's HEAT) online platform. The measures were computed separately for each of the three surveys, and their estimates were compared. Results: The findings revealed an 8.4% decline in at least four ANC visits between 2006 and 2017–18. The decline occurred irrespective of age, educational status, economic status, place of residence, and region. Region-related inequalities were the largest and increased slightly between 2006 (D = 54.6; R = 2.6; PAF = 47.8, PAR = 29.0) and 2017–18 (D = 55.8; R = 3.1; PAF = 57.2, PAR = 29.8). Education (2006: D = 31.3, R = 1.6, PAF = 40.5, PAR = 24.5; 2017–18: D = 25.2, R = 1.6, PAF = 34.9, PAR = 18.1) and rural-urban (2006: D = 16.8, R = 1.3, PAF = 17.8, PAR = 10.8; 2017–18: D = 11.2, R = 1.2, PAF = 13.1, PAR = 6.8) inequalities reduced while economic status inequalities did not improve (2006: D = 48, R = 2.2, PAF = 44.5, PAR = 26.9; 2017–18: D = 43.9, R = 2.4, PAF = 45.0, PAR = 23.4). Age inequalities were very minimal. Conclusion: ANC inequalities remain deeply ingrained in Benin. Addressing their varying levels requires comprehensive strategies that encompass both supply—and demand-side interventions, focusing on reaching uneducated women in the poorest households and those residing in rural areas and Atacora. [ABSTRACT FROM AUTHOR]

Background: Improving maternal healthcare services is crucial to achieving the Sustainable Development Goal (SDG-3), which aims to reduce maternal mortality and morbidity. There is a consensus among different researchers that proper utilization of maternal healthcare services can improve the reproductive health of women, and this can be achieved by providing Antenatal Care (ANC) during pregnancy, Health Facility Delivery (HFD), and Postnatal Care (PNC) to all pregnant women. The main aim of this study was to investigate the utilization and factors associated with maternal and child healthcare services among women of reproductive age in the pastoralist communities in Kenya. Methods: A cross-sectional survey was conducted among 180 pastoralist women who gave birth in the past two years across ten mobile villages in Marsabit County between 2nd January and 29th February 2019. Three key outcomes were analyzed, whether they attended ANC 4+ visits, delivered at HF, and received PNC. Pearson χ2 test and multivariate logistic regression analysis were conducted by IBM SPSS27.0 following Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) guidelines. The significance level was set at p < 0.05. Results: Of the 180 eligible pastoralist women (mean age 27.44 ± 5.13 years), 92.2% were illiterate, 93.9% were married, 33.3% were in polygamy, and 14.4% had mobile phones. The median commuting distance was 15.00 (10–74) km, 41.7% attended ANC 4+, 33.3% HFD, and 42.8% PNC. Those women residing close (≤ 15 km) to a health facility had a threefold higher ANC 4+ (OR 3.10, 95% CI 1.47–6.53), 2.8-fold higher HFD (OR 2.80, 95% CI 1.34–5.84), and 2.5-fold higher PNC (OR 2.49, 95% CI 1.19–5.22) probability. The likelihood was 30-fold higher for ANC 4+ (OR 29.88, 95% CI 6.68–133.62), 2.5-fold higher for HFD (OR 2.56, 95% CI 0.99–6.63), and 60-fold higher for PNC (OR 60.46, 95% CI 10.43–350.55) in women with mobile phones. A monogamous marriage meant a fivefold higher ANC 4+ (OR 5.17, 95% CI 1.88–14.23), 1.6-fold higher HFD (OR 1.67, 95% CI 0.77–3.62), and a sevenfold higher PNC (OR 7.05, 95% CI 2.35–21.19) likelihood. Hosmer Lemeshow test indicated a good-fitting model for ANC 4+, HFD, and PNC (p = 0.790, p = 0.441, p = 0.937, respectively). Conclusion: In conclusion, the utilization of three essential maternal health services is low. Geographic proximity, monogamous marriage, and possession of mobile phones were significant predictors. Therefore, it is recommended that stakeholders take the initiative to bring this service closer to the pastoralist community by providing mobile health outreach and health education. Plain Language Summary: Attending maternal healthcare clinics is essential to reduce maternal deaths and infections. This can be achieved by receiving antenatal care, delivering at health facilities, and checkups after delivery. We investigated the utilization and factors associated with maternal and child healthcare services among pastoralist women of reproductive age who have given birth in the past two years. Of one hundred and eighty women who participated, most of them were illiterate; the majority were married, of which almost a quarter were in polygamous marriages. This population's uptake of antenatal care, delivery in health facilities, and checkups after delivery is low. This means, that walking distance to the health facility was more than 15 km, almost half of women attended antenatal care and received checkups after delivery but only thirty-three percent delivered at a health facility. Geographic proximity, monogamy, and possession of mobile phones for communication were significant in determining the usage of maternal health care. Living close to a health facility means almost three times more antenatal care, two times more health facility delivery, and checkups after delivery. Women with mobile phones showed twenty-seven more times chances to attend antenatal care, more than four times chances to deliver in a health facility and sixty times more chances of having checkups after delivery. Monogamous marriage showed five times higher odds to attend ANC 4+ visits, and seven times having checkups after delivery. Therefore, it is recommended that stakeholders take the initiative to bring this service closer to the pastoralist community. [ABSTRACT FROM AUTHOR]

Objective Methods Results Conclusion ClinicalTrials The present study examined the effects of a nurse‐led family empowerment program on the quality of life of Palestinian pregnant adolescents.This was a randomized controlled trial with a two‐group pre−/post‐test design. The sample consisted of 58 pregnant adolescents recruited from six governmental primary health care clinics in Palestine. Participants were randomly allocated in equal numbers to either the control group (n = 29), which received routine care, or the experimental group (n = 29), which received both routine care and the study program. Data collection instruments included a demographic form and the WHO Quality of Life‐BREF (WHOQoL‐BREF). Data were collected twice: at 32 or 33 weeks' gestation to establish a baseline and at 36 or 37 weeks' gestation post‐test. Statistical analyses were performed and included descriptive statistics, chi‐square and t‐tests.The study findings indicated a significant increase in the mean quality of life scores of the experimental group in the post‐test compared to the pre‐test (P < 0.001). Additionally, pregnant adolescents in the experimental group demonstrated significantly higher post‐test QoL scores than those in the control group (P < 0.001).The nurse‐led family empowerment program emerges as a viable and efficacious alternative intervention for improving the quality of life among Palestinian pregnant adolescents.The study was registered with the NIH U.S. National Library of Medicine ClinicalTrials.gov on 01/09/2021 with the registration code NCT05031130. It can be accessed via this link: https://classic.clinicaltrials.gov/ct2/show/NCT05031130. [ABSTRACT FROM AUTHOR]

Background: The maternal lipid profile has been increasingly recognized as a significant factor influencing pregnancy outcomes. Dyslipidemia during pregnancy can have adverse effects on both the mother and the fetus, potentially leading to complications such as preeclampsia, gestational diabetes, preterm delivery, and fetal growth restrictions. Understanding the relationship between maternal lipid levels and adverse pregnancy outcomes is crucial for developing strategies to improve maternal and fetal health. Aim and Objectives : To investigate the relationship between maternal lipid profiles and adverse pregnancy outcomes, emphasizing the potential mechanisms and clinical implications. Materials and Method: This study was a prospective cohort study conducted at the Obstetrics and Gynecology Department of Kakatiya Medical College/Hospital. Warangal, for the duration of one year. The study included 80 pregnant women attending the antenatal clinic at our institute, after getting informed consent from patients and approved by institutional Review board and meeting inclusion and exclusion criterial Results : majority of the patients were form age group of 26-30 Years, followed by 21 - 25 years, majority of the patients had normal BMI followed by Underweight(<18.5). Education showed graduation and above among most of the study participants followed by intermediate, and most of the patients underwent LSCS. study found that elevated levels of total cholesterol and LDL were significantly associated with an increased risk of preeclampsia and gestational diabetes. Higher triglyceride levels were also correlated with an increased likelihood of preterm birth and low birth weight. Conclusion: Assessing the serum lipid profile during pregnancy can serve as an early and cost-effective method to prevent the harmful effects of pregnancy-related hyperlipidemia. [ABSTRACT FROM AUTHOR]

Objectives: Antenatal education (ANE) is part of National Health Service (NHS) care and is recommended by The National Institute for Health and Care Excellence (NICE) to increase birth preparedness and help pregnant women/birthing people develop coping strategies for labour and birth. We aimed to understand antenatal educator views about how current ANE supports preparedness for childbirth, including coping strategy development with the aim of identifying targets for improvement. Methods: A United Kingdom wide, cross-sectional online survey was conducted between October 2019 and May 2020. Antenatal educators including NHS midwives and private providers were purposively sampled. Counts and percentages were calculated for closed responses and thematic analysis used for open text responses. Results: Ninety-nine participants responded, 62% of these did not believe that ANE prepared women for labour and birth. They identified practical barriers to accessing ANE, particularly for marginalised groups, including financial and language barriers. Educators believe class content is medically focused, and teaching is of variable quality with some midwives being ill-prepared to deliver antenatal education. 55% of antenatal educators believe the opportunity to develop coping strategies varies between location and educators and only those women who can pay for non-NHS classes are able to access all the coping strategies that can support them with labour and birth. Conclusions for Practice: Antenatal educators believe current NHS ANE does not adequately prepare women for labour and birth, leading to disparities in birth preparedness for those who cannot access non-NHS classes. To reduce this healthcare inequality, NHS classes need to be standardised, with training for midwives in delivering ANE enhanced. Significance: What is Already Known on this Subject?: There is no detailed national guidance about the content or quantity of antenatal education that should be delivered by the NHS to patients and, how coping strategies are developed within these sessions is unknown. What this Study Adds?: Antenatal educators believe that quality of antenatal education needs to be improved. Access to coping strategies for labour and birth is hindered by the type of class, the educator's approach and socioeconomic status. This study can be used to support an argument for addressing the inequality in access to antenatal preparation, whilst better preparing all women through higher quality of antenatal education provision in the NHS. [ABSTRACT FROM AUTHOR]

• Women with decision-making autonomy adhere more to the recommended eight antenatal care contact schedule. • Balancing joint decision-making with individual autonomy is crucial for optimal antenatal care utilization. • Partner support influences women's adherence to the eight antenatal care contact schedules. • The number of ANC visits was compared with the WHO-recommended schedule to assess adherence. Maternal and child health outcomes remain a challenge in Uganda. Antenatal care (ANC) is effective in mitigating pregnancy and childbirth risks. Women's decision-making autonomy and partner support are crucial for adherence to ANC contacts and better pregnancy outcomes. We assessed the impact of women's decision-making autonomy and partner support on adherence to the 8 + ANC contact schedule among post-partum mothers in Eastern Uganda. A multicenter cross-sectional study was conducted in four tertiary health facilities in Eastern Uganda, utilizing quantitative techniques to collect data from 1077 postnatal mothers. Eligible participants were those who had given birth within the previous 48 h and had documentation of ANC contacts from their pregnancy. Data was collected using structured questionnaires and analyzed using multivariable logistic regression to assess factors associated with adherence to the WHO-recommended 8 + ANC contacts. Most women were aged 20–34 years (792; 73.5 %). Only 253 (23.5 %) women adhered to the 8 + ANC contacts. A significant proportion lacked decision-making autonomy (839; 77.9 %), and over half reported partner support (550; 51.2 %). Decision-making autonomy and partner support were significantly associated with adherence to the 8 + ANC contacts (aOR: 1.6, 95 % CI: 1.2 – 2.2, p = 0.005) and (aOR: 1.9, 95 % CI: 1.4 – 2.7, p < 0.001), respectively. Women with at least five children had lower adherence to the 8 + ANC contacts (aOR=0.4, 95 % CI: 0.2 – 0.7, p = 0.002). Empowering women and engaging their partners can improve maternal health service utilization and increase ANC contact adherence, leading to better maternal and neonatal health outcomes. [ABSTRACT FROM AUTHOR]

Background: As utilization of individual antenatal care (I-ANC) has increased throughout sub-Saharan Africa, questions have arisen about whether individual versus group-based care might yield better outcomes. We implemented a trial of group-based antenatal care (G-ANC) to determine its impact on birth preparedness and complication readiness (BPCR) among pregnant women in Ghana. Methods: We conducted a cluster randomized controlled trial comparing G-ANC to routine antenatal care in 14 health facilities in the Eastern Region of Ghana. We recruited women in their first trimester to participate in eight two-hour interactive group sessions throughout their pregnancies. Meetings were facilitated by midwives trained in G-ANC methods, and clinical assessments were conducted in addition to group discussions and activities. Data were collected at five timepoints, and results are presented comparing baseline (T0) to 34 weeks' gestation to 3 weeks post-delivery (T1) for danger sign recognition, an 11-point additive scale of BPCR, as well as individual items comprising the scale. Results: 1285 participants completed T0 and T1 assessments (N = 668 I-ANC, N = 617, G-ANC). At T1, G-ANC participants were able to identify significantly more pregnancy danger signs than I-ANC participants (mean increase from 1.8 to 3.4 in G-ANC vs. 1.7 to 2.2 in I-ANC, p < 0.0001). Overall BPCR scores were significantly greater in the G-ANC group than the I-ANC group. The elements of BPCR that showed the greatest increases included arranging for emergency transport (I-ANC increased from 1.5 to 11.5% vs. G-ANC increasing from 2 to 41% (p < 0.0001)) and saving money for transportation (19–32% in the I-ANC group vs. 19–73% in the G-ANC group (p < 0.0001)). Identifying someone to accompany the woman to the facility rose from 1 to 3% in the I-ANC group vs. 2–20% in the G-ANC group (p < 0.001). Conclusions: G-ANC significantly increased BPCR among women in rural Eastern Region of Ghana when compared to routine antenatal care. Given the success of this intervention, future efforts that prioritize the implementation of G-ANC are warranted. Trial registration: ClinicalTrials.gov Identifier: NCT04033003 (25/07/2019). Protocol available: Protocol Available at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9508671/. [ABSTRACT FROM AUTHOR]

Objective: The aim of the present study was to explore inequalities in antenatal care (ANC) in South Korea. Based on the guidelines of the WHO, we categorized less than eight visits to an obstetrical facility as insufficient ANC. We examined ANC inequalities associated with age, disability, nationality, income, and geographic accessibility. Methods: We extracted delivery event claimed from 2013 to 2022 from the National Health Insurance Service database. By tracing back 270 days from the delivery date, we counted the number of antenatal visits for each childbirth and calculated the proportion of women with insufficient ANC and assessed both absolute and relative inequalities for each population group. The logistic regression analysis for both underuse and overuse of ANC were conducted. Results: Out of 3 416 517 childbirths, 104 109 women (3.0%) had fewer than eight ANC visits. Although the average number of ANC visits reached 18.7 in 2022, significant inequalities persisted across different population groups. The insufficient ANC rate was 28.1% for teenage women, 6.4% for disabled women, 10.7% for non‐Korean women, and 15.2% for dependents of medical aid households. Women with low income and those living in obstetric care underserved areas also exhibited higher ANC insufficiency. From 2021 to 2022, sufficiency in ANC decreased for teenage, disabled, and non‐Korean women, highlighting the effects of the COVID‐19 pandemic. Conclusion: Antenatal care inequalities are evident in South Korea's well‐resourced health system. There is a need for further investigation into these disparities and the qualitative aspects of maternity care services. Synopsis: Despite South Korea's well‐equipped health system, significant antenatal care inequalities exist, necessitating further exploration and qualitative analysis of maternity care gaps. [ABSTRACT FROM AUTHOR]

Background: The WHO 2016 antenatal care (ANC) policy recommends at least eight antenatal contacts during pregnancy. This study assessed ANC8 uptake following policy implementation and explored the relationship between ANC attendance and intermittent preventive treatment in pregnancy (IPTp) coverage in sub-Saharan Africa following the rollout of the World Health Organization (WHO) 2016 ANC policy, specifically, to assess differences in IPTp uptake between women attending eight versus four ANC contacts. Methods: A secondary analysis of data from 20 sub-Saharan African countries with available Demographic Health and Malaria Indicator surveys from 2018 to 2023 was performed. The key variables were the number of ANC contacts and IPTp doses received during a participant's last completed pregnancy in the past two years. Pooled crude and multivariable logistic regression models were used to explore factors associated with attendance of at least four or eight ANC contacts as well as receipt of at least three doses of IPTp during pregnancy. Results: Overall, only a small proportion of women (median = 3.9%) completed eight or more ANC contacts (ANC8 +). Factors significantly associated with increased odds of ANC8 + included early ANC attendance (AOR: 4.61: 95% CI 4.30—4.95), literacy (AOR: 1.20; 95% CI 1.11—1.29), and higher wealth quintile (AOR: 3.03; 95% CI 2.67—3.44). The pooled estimate across all countries showed a very slight increase in the odds of IPTp3 + among women with eight (AOR: 1.06; 95% CI 1.00—1.12) compared to those with four contacts. In all but two countries, having eight instead of four ANC contacts did not confer significantly greater odds of receiving three or more doses of IPTp (IPTp3 +), except in Ghana (AOR: 1.67; 95% CI 1.38—2.04) and Liberia (AOR: 1.43; 95% CI 1.18—1.72). Conclusion: Eight years after the WHO ANC policy recommendation, all countries still had sub-optimal ANC8 + coverage rates. This paper is a call to action to actualize the vision of the WHO and the global malaria community of a malaria free world. Policies to improve ANC and IPTp coverage should be operationalized with clear actionable guidance and local ownership. Study findings can be used to inform multi-level policy, programmatic, and research recommendations to optimize ANC attendance and malaria in pregnancy prevention, thus improving maternal and child health outcomes, including the reduction of malaria in pregnancy. [ABSTRACT FROM AUTHOR]

Background This study aimed to explore the relationship between women's empowerment and utilization of maternity care for married Afghan women aged 15–49 y in Afghanistan, assessing the convergence validity of the Survey-based Women's Empowerment Index in Afghanistan (SWEI-A). Methods The study used data from the 2015 Afghanistan Demographic Health Survey to examine the association of different domains of women's empowerment with the utilization of maternity care using multilevel Poisson regression at both individual and community levels. Results The utilization of maternity services was considerably higher among women with high scores compared with those with low scores in almost all domains of the SWEI-A, except for property owning, in which women with high scores appeared to have lower rates of utilization of such services compared with those with low scores. At the community level, those communities with high participation of women in the labor force were less likely to have adequate antenatal care (ANC), institutional delivery and postnatal care (PNC). Individual-level literacy was associated with higher utilization of ANC, institutional delivery and PNC, contrary to community-level literacy. Conclusions Except for property owning, the high score in almost all other domains was associated with higher utilization of maternity care, which indicates an acceptable level of convergence validity for the developed index (i.e. the SWEI-A) in measuring women's empowerment among married Afghan women aged 15–49 y. [ABSTRACT FROM AUTHOR]

The objective of this study was to investigate the relationship between women's healthcare autonomy and the utilization of maternal healthcare services (MHS), including antenatal care services, the services of health professionals at the birth of a child, and facility-based delivery. This was a cross-sectional study. This study utilized data from the 2015 Afghanistan Demographic and Health Survey (AFDHS 2015), which included women aged 15–49 years who had given live birth within the five years before the survey. Multilevel logistic regression was used to estimate the adjusted odd ratios (AOR) for each outcome variable. Among respondents, 16.49% made at least four ANC visits, 52.57% of childbirth were assisted by a skilled birth attendant (SBA), and 45.60% of children were born in health facilities. Women with high healthcare autonomy, compared to medium and low, were more likely to use ANC (AOR 1.45; 95% CI = 1.26–1.67), SBA (AOR 1.15; 95% CI 1.02–1.29), and FBD (AOR 1.12; 95% CI 1.04–1.20). The association between women's healthcare autonomy and the use of maternal healthcare services (MHS) was positively and significantly moderated by household wealth and women's access to media. Women's higher healthcare autonomy was significantly and positively associated with MHS in Afghanistan. Policy and programs that encourage women's empowerment and awareness of the importance of MHS utilization should be initiated. [ABSTRACT FROM AUTHOR]

Introduction: Family planning (FP) is important in reducing maternal morbidity and mortality as well as foetal and neonatal complications. This study aimed to determine the intention to practise FP among antenatal women at risk of gestational diabetes mellitus (GDM) in the Klang Health District and its associated factors. Methods: A cross-sectional study was conducted at four government health clinics in the Klang Health District. A total of 431 antenatal women at risk of GDM were recruited using systematic random sampling. A validated self-administered questionnaire was used to assess knowledge, attitude, previous practice and intention to use FP after delivery. Multiple logistic regression (MLR) was used to determine the factors associated with the intention to practise FP. Results: Approximately 64.7% (n=279) of the respondents intended to practise FP. MLR showed that the factors associated with the intention to practise FP were Malay ethnicity (odds ratio [OR]=3.319, 95% confidence interval [CI]=1.431-7.697), low income (OR=2.174, 95% CI=1.317-3.588), good knowledge (OR=2.591, 95% CI=1.008-6.174) and good previous practice (OR=3.956, 95% CI=1.428-9.052). Conclusion: The prevalence of the intention to practise FP among antenatal women at risk of GDM was 64.7%. Malay antenatal women from low-income households with good knowledge and previous practice were more likely to have the intention to practise FP after delivery. Thus, interventions targeted at non-Malay women and measures to improve their knowledge might help improve the intention and uptake of FP among these women. [ABSTRACT FROM AUTHOR]

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. [ABSTRACT FROM AUTHOR]

Background: Utilizing antenatal care (ANC) is vital for maternal and neonatal well-being, especially in low-resource settings with healthcare challenges. Identifying factors impacting antenatal care this context, t of current situation in Sudan is crucial for developing strategies to improve maternal care. This study explores ANC utilization amidst COVID-19, security issues, and healthcare instability in primary health care centers in a resource-constrained environment, aiming to enhance maternal care access and quality. Methods: This is a mixed-methods study. Quantitative data were collected through a retrospective analysis of ANC attendance records before and during the pandemic. Demographic variables were analyzed for their association with ANC utilization. In-depth interviews were conducted to collect qualitative data from pregnant women and healthcare providers. These interviews focused on capturing the experiences, perceptions, and obstacles associated with antenatal care services during the pandemic and within the healthcare system challenges. Results: Preliminary quantitative analysis revealed a significant decline in ANC utilization during the pandemic. Fear of COVID-19 infection, disrupted transportation, and resource constraints have emerged as significant barriers to ANC attendance. The qualitative findings highlighted the impact of security challenges on healthcare access and the adaptation strategies employed, including mobile ANC clinics and telehealth consultations. Conclusion: This study illuminates the intricate landscape of ANC utilization in the face of a pandemic, security instability, and healthcare system vulnerability. Policymakers and stakeholders should collaborate to strengthen healthcare systems and ensure the continued provision of essential maternal health services during challenging times. [ABSTRACT FROM AUTHOR]

Background: Early antenatal care visit is important for optimal care and health outcomes for women and children. In the study area, there is a lack of information about the time to initiation of antenatal care. So, this study aimed to determine the time to initiation of antenatal care visits and its predictors among pregnant women who delivered in Arba Minch town public health facilities. Methods: An institution-based retrospective follow-up study was performed among 432 women. A systematic random sampling technique was employed to select the study participants. The Kaplan-Meier survival curve was used to estimate the survival time. A Multivariable Cox proportional hazard regression model was fitted to identify predictors of the time to initiation of antenatal care. An adjusted hazard ratio with a 95% confidence interval was used to assess statistical significance. Results: The median survival time to antenatal care initiation was 18 weeks (95% CI = (17, 19)). Urban residence (AHR = 2.67; 95% CI = 1.52, 4.71), Tertiary and above level of education of the women (AHR = 1.90; 95% CI = 1.28, 2.81), having pregnancy-related complications in a previous pregnancy (AHR = 1.53; 95% CI = 1.08, 2.16), not having antenatal care for previous pregnancy (AHR = 0.39; 95% CI = 0.21, 0.71) and unplanned pregnancy (AHR = 0.66; 95% CI = 0.48, 0.91) were statistically significant predictors. Conclusion: Half of the women initiate their antenatal care visit after 18 weeks of their pregnancy which is not in line with the recommendation of the World Health Organization. Urban residence, tertiary and above level of education of the women, having pregnancy-related complications in a previous pregnancy, not having previous antenatal care visits and unplanned pregnancy were predictors of the time to initiation of antenatal care. Therefore, targeted community outreach programs including educational campaigns regarding antenatal care for women who live in rural areas, who are less educated, and who have no previous antenatal care experience should be provided, and comprehensive family planning services to prevent unplanned pregnancy are needed. [ABSTRACT FROM AUTHOR]

Background: In group-based pregnancy models, antenatal care and childbirth/parenting education are provided in groups of eight to 10 women, usually with two midwives, and six to eight sessions. Current evidence is inconclusive regarding potential benefit or harm. We aimed to explore the feasibility of implementing an adequately powered randomised controlled trial (RCT). Methods: A two-arm pilot RCT was conducted in a tertiary maternity hospital in Melbourne, Australia. Women were randomly allocated to either the intervention to receive group-based antenatal care and education (group care) or to usual care, which included hospital-based midwife, caseload midwifery, team midwifery, or GP shared care. Participants were English-speaking, primiparous, low risk, and < 24 weeks gestation at booking. Data collection: feasibility measures throughout pilot, baseline questionnaire at recruitment, clinical outcome data from the medical record, and a telephone-administered questionnaire 6 weeks postpartum. A focus group explored midwives' views. Results: Seventy-four women were recruited from May to June 2017 (group care = 40, usual care = 34). Study uptake was 35%. Women allocated to group care rated their overall pregnancy care more highly (88% good/very good vs 77% in usual care). There was no evidence of harm related to group care. Overarching themes from the midwives were that group care helped 'build connections' and 'empower women'. All midwives would work in the model again and believed it should be expanded. Conclusion: Group care was acceptable to both women and midwives with no evidence of harm. The pilot demonstrated the feasibility of undertaking a large adequately powered RCT, important given the inconclusive evidence on clinical outcomes regarding the model, and its current relatively widespread implementation. Trial registration: Australian New Zealand Clinical Trials Registry (ANZCTR): ACTRN12623000858695. [ABSTRACT FROM AUTHOR]

Background: In the quest for quality antenatal care (ANC) and positive pregnancy experience, the value of comprehensive woman hand-held case notes cannot be emphasised enough. However, the woman's health passport book in Malawi presents gaps which hinder provision of quality care, especially during pregnancy. We aimed to develop a compressive updated woman hand-held case notes tool (health passport book) which reflects WHO 2016 ANC guidelines in Malawi. Methods: From July 2022 to August 2022, we applied a co-creative participatory approach in 3 workshops with key stakeholders to compare the current ANC tool contents to the WHO 2016 ANC guidelines, decide on key elements to be changed to improve adherence and change in practice, and redesign the woman's health passport tool to reflect the changes. Within-group discussions led to whole-group discussions and consensus, guided by a modified nominal group technique. Facilitators guided the discussions while ensuring autonomy of the group members in their deliberations. Discussions were recorded and transcribed. Data was analysed through thematic analysis, and reduction and summaries in affinity diagrams. The developed tool was endorsed for implementation within Malawi's healthcare system by the national safe motherhood technical working group (TWG) in July 2023. Results: Five themes were identified in the analysis. These were (i) critical components in the current tool missed, (ii) reimagining the current ANC tool, (iii) opportunity for ultrasound scanning conduct and documentation, (iv) anticipated barriers related to implementation of the newly developed tool and (v) cultivating successful implementation. Participants further recommended strengthening of already existing policies and investments in health, strengthening public private partnerships, and continued capacity building of healthcare providers to ensure that their skill sets are up to date. Conclusion: Achieving goals of quality ANC and universality of healthcare are possible if tools in practice reflect the guidelines set out. Our efforts reflect a pioneering attempt in Malawi to improve women's hand-held case notes, which we know help in enhancing quality of care and improve overall women's satisfaction with their healthcare system. [ABSTRACT FROM AUTHOR]

Stillbirth is a major cause of perinatal death in India. Deciphering the cause of stillbirth will help in formulating prevention strategies to bring down the stillbirth rate. Our objective is to explore the antepartum and intrapartum causes and risk factors of stillbirths. Materials and methods: This was a prospective observational study done under WHO-SEARO project. This study included all stillbirths occurring in Safdarjung Hospital from August 2015 to December 2018. Verbal autopsies were done, and thorough antenatal records were documented and analyzed. Results: Out of 1,09,578 deliveries, 2,689 were stillbirths (2.4%). Among these, 1,583 (58.9%) were unsupervised and unbooked pregnancies, whereas 1,106 (41.1%) pregnancies were supervised and booked. Significantly lower percentage of patients in unbooked pregnancies had iron–folic acid intake; significantly higher percentage of mothers had anemia, hypertension, diabetes, and antepartum hemorrhage compared with booked pregnancies. Among antepartum causes, hypertension (23.4%), abruption (18.5%), and infection (3.4%) were the leading causes for stillbirths. Intrapartum causes constituted 39% of total stillbirths; a higher percentage was in the unbooked pregnancies. Approximately, 89% of patients with stillbirth had delayed seeking of healthcare facility. Conclusion: The most common cause of stillbirth was hypertensive disorders of pregnancy followed by abruptio placentae in this cohort. Various maternal-related factors are significantly higher in unbooked pregnancies. Reducing these factors might reduce the prevalence of stillbirth. [ABSTRACT FROM AUTHOR]

Background: HIV partner counselling and testing in antenatal care (ANC) is a crucial strategy to raise the number of males who know their HIV status. However, in many settings like Tanzania, male involvement in antenatal care remains low, and there is a definite need for innovative strategies to increase male partner involvement. This study was designed to evaluate the efficacy of mobile phone intervention increase male partner ANC attendance for HIV testing in Moshi municipal, Tanzania. Methods: Between April and July 2022, we enrolled pregnant women presenting to a first ANC visit at Majengo and St. Joseph reproductive health facilities without their male partners. Eligible pregnant women were randomly assigned to invitation of their male partners either via phone calls, text messages from clinic staff and verbal invites from pregnant partners (intervention arm) or verbal invites only from the pregnant partners (control arm). Neither healthcare provider nor participant were blinded. The primary outcome was the proportion of male partners who attended ANC with their pregnant partners during a follow-up period of two consecutive visits. The secondary outcome measure was HIV testing among male partners following the invitation. Participants were analyzed as originally assigned (intention to treat). Results: A total of 350 pregnant women presenting to ANC for the first time were enrolled, with 175 women enrolled in each arm. The efficacy of male attendance with their pregnant women following the invitations was 83.4% (147/175) in the intervention arm and 46.3% (81/175) in the control arm. Overall, the results suggest a positive and statistically significant average treatment effect among men who received mobile phone intervention on ANC attendance. For the secondary outcome, the percent of male partners who accepted HIV counselling and testing was 99.3% (146/147) in the intervention arm and 93.8% (76/81) in the control arm. Married men were having higher odds of ANC attendance compared with single men (aOR:6.40(3.26–12.56), Males with multigravida women were having lower odds of ANC attendance compared with primigravida women (aOR:0.17(0.09–0.33). Conclusion: The study demonstrates that supplementing verbal invitations with mobile phone calls and text messages from clinic staff can significantly increase male partner ANC attendance and HIV testing. This combined approach is recommended in improving ANC attendance and HIV testing of male partners who do not accompany their pregnant partners to antenatal clinics in the first visits. Trial registration: PACTR202209769991162. [ABSTRACT FROM AUTHOR]

Background: Antenatal care services play a crucial role in promoting positive pregnancy outcomes by facilitating the early identification of pregnancy risk factors and early diagnosis of pregnancy-related complications. This study aimed to assess the frequency and timing of ANC attendance of mothers in Ghana as well as determine the predictors of early ANC attendance. Methods: The data for this study was extracted from the 2017 Ghana Maternal Health Survey (GMHS). The study population was women aged 15–49 years with a live birth or stillbirth in the 5 years preceding the survey. Data was analysed using STATA/SE version 17, using descriptive statistics and multiple binary logistic regression analysis. Results: It was found that 44.4% of the women obtained eight (8) + ANC visits. A majority of the women (66%) initiated ANC visits in the first trimester of pregnancy. Early ANC visit was significantly associated with age of the respondent, education, wealth index, religion, region and reason for first ANC visit. For instance, women between the ages of 25–29 years (aOR = 1.75, 95% CI: 1.31–2.33) had increased odds of early ANC visit compared to those aged 15–19 years. Women with higher education (aOR = 1.83, 95% CI: 1.27–2.64) were about twice as likely to initiate early ANC visits compared to those with no education. Also, women in the highest wealth index (aOR = 2.43, 95% CI: 1.83–3.23) were two times more likely to initiate early ANC visits compared to those in the lowest wealth index. Conclusion: This study has shown that a majority of women in Ghana start their first ANC visit during the first trimester of pregnancy. A considerable proportion of the women failed to meet the WHO's recommendation of having a minimum of eight ANC visits throughout pregnancy. Early ANC visit was determined by socio-demographic factors. Going forward, it should be a priority for stakeholders to ensure that ANC services are accessible to all mothers in a timely manner. [ABSTRACT FROM AUTHOR]

Background: Utilization of maternal healthcare services has a direct bearing on maternal mortality but is contingent on a wide range of socioeconomic factors, including the sex of the household head. This paper studies the role of the sex of the household head in the utilization of maternal healthcare services in India using data from the National Family Health Survey-V (2019–2021). Methods: The outcome variable of this study is maternal healthcare service utilization. To that end, we consider three types of maternal healthcare services: antenatal care, skilled birth assistance, and postnatal care to measure the utilization of maternal healthcare service utilization. The explanatory variable is the sex of the household head and we control for specific characteristics at the individual level, household-head level, household level and spouse level. We then incorporate a bivariate logistic regression on the variables of interest. Results: 24.25% of women from male-headed households have complete utilization of maternal healthcare services while this proportion for women from female-headed households stands at 22.39%. The results from the bivariate logistic regression confirm the significant impact that the sex of the household head has on the utilization of maternal healthcare services in India. It is observed that women from female-headed households in India are 19% (AOR, 0.81; 95% CI: 0.63,1.03) less likely to utilize these services than those from male-headed households. Moreover with higher levels of education, there is a 25% (AOR, 1.25; 95% CI: 1.08,1.44) greater likelihood of utilizing maternal healthcare services. Residence in urban areas, improved wealth quintiles and access to healthcare facilities significantly increases the chances of maternal healthcare utilization. The interaction term between the sex of the household head and the wealth quintile the household belongs to, (AOR, 1.39; 95% CI: 1.02, 1.89) shows that the utilization of maternal healthcare services improves when the wealth quintile of the household improves. Conclusion: The results throw light on the fact that the added expenditure on maternal healthcare services exacerbates the existing financial burden for the economically vulnerable female-headed households. This necessitates the concentration of research and policy attention to alleviate these households from the sexual and reproductive health distresses. Trial Registration: Not Applicable. JEL Classification: D10, I12, J16. [ABSTRACT FROM AUTHOR]

Background: Diabetes during pregnancy has negative effects on both mothers and their fetuses. To improve perinatal outcomes and women's experience of care, the World Health Organization (WHO) suggests implementing health system interventions to enhance the use and quality of antenatal care. The main goal of this study is to implement and evaluate the outcomes of the Centering Pregnancy group care model for pregnant women with diabetes. Methods/design: The study will consist of three phases: a quantitative phase, a qualitative phase, and a mixed phase. In the quantitative phase, a randomized controlled trial will be conducted on 100 pregnant women with diabetes receiving prenatal care in Tabriz City, Iran. The Summary of Diabetes Self-Care Activities (SDSCA) questionnaire will also be validated in this phase. The qualitative phase will use qualitative content analysis with in-depth and semi-structured individual interviews to explore pregnant women's understanding of the impact of the Centering Pregnancy group care model on their care process. The mixed phase will focus on the degree and extent of convergence between quantitative and qualitative data. Discussion: The implementation of the Centering Pregnancy group care approach is anticipated to empower women in effectively managing their diabetes during pregnancy, resulting in improved outcomes for both mothers and newborns. Furthermore, adopting this approach has the potential to alleviate the financial burden of diabetes on healthcare system. Trial registration: Iranian Registry of Clinical Trials (IRCT): (IRCT20120718010324N80/ Date of registration: 2024-01-03). URL: https://irct.behdasht.gov.ir/trial/74206. Plain Language Summary: Diabetes during pregnancy, whether pre-existing or gestational, can lead to complications for both the mother and the baby. Gestational diabetes is common and poses risks such as preterm birth and cesarean delivery. Pre-existing diabetes is on the rise globally and increases the likelihood of adverse outcomes like fetal death and birth defects. Centering Pregnancy is a group-based prenatal care model that offers comprehensive care to women with similar gestational ages. It promotes behavior modification, social support, and knowledge exchange among participants. However, there is limited research on the effectiveness of this model specifically for women with diabetes, especially in Iran. To address this research gap, the study aims to implement and evaluate the Centering Pregnancy model in pregnant women with diabetes in Iran. By employing a combined methodology, the researchers will assess the current state of care and gather comprehensive data to understand the impact of the model. The findings of this study can contribute to improving the healthcare system's burden and enhancing self-care practices for pregnant women with diabetes, ultimately leading to better pregnancy experiences and improved maternal and neonatal outcomes. [ABSTRACT FROM AUTHOR]

Background: Antenatal care (ANC) is critical to reducing maternal and infant mortality. However, sub-Saharan Africa (SSA) continues to have among the lowest levels of ANC receipt globally, with half of mothers not meeting the WHO minimum recommendation of at least four visits. Increasing ANC coverage will require not only directly reducing geographic and financial barriers to care but also addressing the social determinants of health that shape access. Among those with the greatest potential for impact is maternal education: past research has documented a relationship between higher educational attainment and antenatal healthcare access, as well as related outcomes like health literacy and autonomy in health decision-making. Yet little causal evidence exists about whether changing educational policies can improve ANC coverage. This study fills this research gap by investigating the impact of national-level policies that eliminate tuition fees for lower secondary education in SSA on the number of ANC visits. Methods: To estimate the effect of women's exposure to tuition-free education policies at the primary and lower secondary levels on their ANC visits, a difference-in-difference methodology was employed. This analysis leverages the variation in the timing of education policies across nine SSA countries. Results: Exposure to tuition-free primary and lower secondary education is associated with improvements in the number of ANC visits, increasing the share of women meeting the WHO recommendation of at least four ANC visits by 6–14%. Moreover, the impact of both education policies combined is greater than that of tuition-free primary education alone. However, the effects vary across individual treatment countries, suggesting the need for further investigation into country-specific dynamics. Conclusions: The findings of this study have significant implications for policymakers and stakeholders seeking to improve ANC coverage. Removing the tuition barrier at the secondary level has shown to be a powerful strategy for advancing health outcomes and educational attainment. As governments across Africa consider eliminating tuition fees at the secondary level, this study provides valuable evidence about the impacts on reproductive health outcomes. While investing in free education requires initial investment, the long-term benefits for both human development and economic growth far outweigh the costs. [ABSTRACT FROM AUTHOR]

Background: Sustainable Development Goal (SDG) 3.7 aims to ensure universal access to sexual and reproductive healthcare services, where antenatal care (ANC) is a core component. This study aimed to examine the influence of health facility availability and readiness on the uptake of four or more ANC visits in Bangladesh. Methods: The 2017/18 Bangladesh Demographic and Health Survey data were linked with the 2017 Health Facility Survey and analyzed in this study. The associations of health facility-level factors with the recommended number of ANC uptakes were determined. A multilevel mixed-effect logistic regression model was used to determine the association, adjusting for potential confounders. Results: Nearly 44% of mothers reported four or more ANC uptakes, with significant variations across several areas in Bangladesh. The average distance of mothers' homes from the nearest health facilities was 6.36 km, higher in Sylhet division (8.25 km) and lower in Dhaka division (4.45 km). The overall uptake of the recommended number of ANC visits was positively associated with higher scores for the management (adjusted odds ratio (aOR) 1.85; 95% CI, 1.16–2.82) and infrastructure (aOR, 1.59; 95% CI, 1.09–2.19) of health facilities closest to mothers' homes. The odds of using the recommended number of ANC in mothers increased by 3.02 (95% CI, 2.01–4.19) and 2.36 (95% CI, 2.09–3.16) folds for each unit increase in the availability and readiness scores to provide ANC services at the closest health facilities, respectively. Every kilometer increase in the average regional-level distance between mothers' homes and the nearest health facilities reduced the likelihood of receiving the recommended number of ANC visits by nearly 42% (aOR, 0.58, 95% CI, 0.42–0.74). Conclusion: The availability of healthcare facilities close to residence, as well as their improved management, infrastructure, and readiness to provide ANC, plays a crucial role in increasing ANC services uptake. Policies and programs should prioritize increasing the availability, accessibility, and readiness of health facilities to provide ANC services. [ABSTRACT FROM AUTHOR]

Background: Fetal growth restriction (FGR) poses challenges in antenatal care due to its association with adverse perinatal outcomes. The cerebroplacental ratio (CPR), derived from Doppler ultrasound measurements, has emerged as a potential marker for evaluating fetal well-being in FGR pregnancies. Aim and Objective: To assess the predictive value of CPR in identifying adverse perinatal outcomes in suspected FGR cases. Materials and Methods: Conducted at Jaipur Golden Hospital, New Delhi, from July 2018 to May 2019, the study included 80 pregnant women with clinical suspicion of FGR, singleton pregnancies, and gestational age over 30 weeks. Doppler studies evaluated the umbilical artery pulsatility index (UA PI) and middle cerebral artery pulsatility index (MCA PI) to calculate CPR. Perinatal outcomes were analyzed, including delivery mode, birth weight below the 10th percentile, APGAR score < 7 at 5 minutes, neonatal interventions, and neonatal intensive care unit (NICU) admission > 24 hours. Statistical analysis employed sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) (p < 0.05). Results: 47.5% had CPR < 1, and 52.5% had CPR = 1. CPR significantly correlated with adverse perinatal outcomes (p < 0.001). It outperformed UA PI and MCA PI, with a sensitivity of 97.6%, specificity of 91.8%, PPV of 93%, and NPV of 97.1%. Conclusion: CPR is valuable in predicting adverse perinatal outcomes in suspected FGR pregnancies, surpassing UA PI and MCA PI in diagnostic accuracy. Further validation and optimization are necessary for managing high-risk pregnancies. [ABSTRACT FROM AUTHOR]

Background: Obstetric ultrasound imaging is a relatively new, but rapidly expanding, technology in low‐ and middle‐income countries (LMICs). Given that new technologies modify practices, the influence of ultrasound on pregnancy management in LMICs is not comprehensively understood. Objectives: To map how ultrasound technology may be modulating the culture of pregnancy management in LMICs. Search Strategy: A search of five databases up to November 18, 2022. Selection Criteria: Original, peer‐reviewed articles from LMICs, published in English from 2000 to 2022. Data Collection and Analysis: All articles were assessed for quality using the GRADE approach. Data were analyzed thematically to generate new interpretive constructs and explanations. Results: Forty articles involving 113 000 respondents suggests that obstetric ultrasound is becoming the preferred method of pregnancy surveillance, replacing clinically important components of prenatal care. Mothers overestimate ultrasound as an all‐powerful diagnostic and "therapeutic" tool that can deliver the perfect baby. For‐profit providers are driving medically unnecessary scans while the poor do not receive the recommended scans. Conclusion: Ultrasound technology has modified the culture of pregnancy management in LMICs in unintended and possibly harmful ways. Private health services are pushing the detrimental trends. Limitations include generalizability of qualitative studies and insufficient attention to inequities. Synopsis: Systematic review of literature shows obstetric ultrasound technology is shaping pregnancy management practices in LMICs in unintended ways with detrimental consequences for safe care. [ABSTRACT FROM AUTHOR]

Background and Purpose: The World Health Organization (WHO) states that good quality antenatal care should strive for both mother and child achieving their best possible health. On a policy level, in Europe these goals are reached with varying approaches. This research offers a fresh look on the underlying assumptions embedded in the ANC policies in three European countries. Methods: A framing analysis was conducted to publicly available ANC policies on uncomplicated pregnancies in Finland, England, and the Netherlands. Analysis was guided by van Hulst and Yanowa and included the following phases: a) Sense-making, b) Selecting, naming, and categorizing and c) Storytelling. Main Findings: Findings of this study demonstrate how ANC is organized with distinct frames. The Finnish ANC policies emphasized equity in care and instead of focusing on women, the ANC focused on the family. In England the pregnant woman was central, and it is seen as her responsibility to understand the ANC protocols. The ANC in the Netherlands focused on the pregnant woman's pregnancy experience and freedom. Conclusion: The three studied countries had individual priorities and values guiding ANC provision. Despite each country being in line with the WHO ANC recommendations, areas requiring improvement should not be overlooked. Significance: What is Already Known on this Subject?: Antenatal care is organized differently in European countries depending on their health system. These varying approaches lead to women's unequal access to good quality care during their pregnancies. Despite maternal mortality being the lowest in Europe compared to other continents, disparities and challenges remain. What this Study Adds?: This study contributes with improved understanding on how antenatal care aims to achieve good maternal health in three European countries by framing the ANC in Finland, England, and the Netherlands. [ABSTRACT FROM AUTHOR]

Despite the vast advantages of making antenatal care visits, the service utilization among pregnant women in Nigeria is suboptimal. A five-year monitoring estimate indicated that about 24% of the women who had live births made no visit. The non-utilization induced excessive zeroes in the outcome of interest. Thus, this study adopted a zero-inflated negative binomial model within a Bayesian framework to identify the spatial pattern and the key factors hindering antenatal care utilization in Nigeria. We overcome the intractability associated with posterior inference by adopting a Pólya-Gamma data-augmentation technique to facilitate inference. The Gibbs sampling algorithm was used to draw samples from the joint posterior distribution. Results revealed that type of place of residence, maternal level of education, access to mass media, household work index, and woman's working status have significant effects on the use of antenatal care services. Findings identified substantial state-level spatial disparity in antenatal care utilization across the country. Cost-effective techniques to achieve an acceptable frequency of utilization include the creation of a community-specific awareness to emphasize the importance and benefits of the appropriate utilization. Special consideration should be given to older pregnant women, women in poor antenatal utilization states, and women residing in poor road network regions. [ABSTRACT FROM AUTHOR]

Background: Utilizing antenatal care (ANC) is vital for maternal and neonatal well-being, especially in low-resource settings with healthcare challenges. Identifying factors impacting antenatal care this context, t of current situation in Sudan is crucial for developing strategies to improve maternal care. This study explores ANC utilization amidst COVID-19, security issues, and healthcare instability in primary health care centers in a resource-constrained environment, aiming to enhance maternal care access and quality. Methods: This is a mixed-methods study. Quantitative data were collected through a retrospective analysis of ANC attendance records before and during the pandemic. Demographic variables were analyzed for their association with ANC utilization. In-depth interviews were conducted to collect qualitative data from pregnant women and healthcare providers. These interviews focused on capturing the experiences, perceptions, and obstacles associated with antenatal care services during the pandemic and within the healthcare system challenges. Results: Preliminary quantitative analysis revealed a significant decline in ANC utilization during the pandemic. Fear of COVID-19 infection, disrupted transportation, and resource constraints have emerged as significant barriers to ANC attendance. The qualitative findings highlighted the impact of security challenges on healthcare access and the adaptation strategies employed, including mobile ANC clinics and telehealth consultations. Conclusion: This study illuminates the intricate landscape of ANC utilization in the face of a pandemic, security instability, and healthcare system vulnerability. Policymakers and stakeholders should collaborate to strengthen healthcare systems and ensure the continued provision of essential maternal health services during challenging times. [ABSTRACT FROM AUTHOR]

Study Design: Cross sectional Background: Antenatal means the period of pregnancy from conception to childbirth. Ante natal classes are sessions designed to give a pregnant female and her husband information about pregnancy, delivery and caring for herself and her newborn after birth. These classes can help improve antenatal care. Methods: A cross sectional study done via online forms using convenience sampling. All married adults above age of 15 with at least 1 child born in Saudi Arabia were included in the study. The sample size was 700. Results: 70%of participants said they did not know about antenatal classes and 94% said they had not attended any antenatal classes before. There was no correlation between age at first pregnancy and knowledge about antenatal care however there was significant association (p=.001) between low knowledge of antenatal events and fear and adverse outcome during first pregnancy. 75% of participants said they would attend antenatal classes if it was available. Major sources of knowledge about these events were mothers, friends or internet. Conclusion and Recommendation: Our results show that most of the knowledge women gain about care during antenatal period is not from a medical source but rather from mothers, relatives or internet. So, we would like to recommend to the ministry of health and concerned authorities and stakeholders to plan and implement antenatal classes and health education sessions for women during their routine antenatal visits. [ABSTRACT FROM AUTHOR]

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. [ABSTRACT FROM AUTHOR]

Background: Antenatal care (ANC) is the care women receive during pregnancy before birth and represents a cornerstone of maternal and child health. Previously, Saudi women faced various barriers to practicing ANC, including challenges related to transportation, low maternal education, poor communication with healthcare centers, and incorrect maternal beliefs. In line with Saudi Vision 2030, this multicenter cross-sectional study aimed to investigate the timing of ANC contact, coverage of service utilization in public hospitals among Saudi mothers, sociodemographic factors and antenatal health care utilization, and beliefs about prenatal vitamins, and supplement use among pregnant Saudi women. Methods: Data was collected from 1230 pregnant women across 11 Ministry of Health (MOH) facilities. The study assessed the timing of ANC initiation, beliefs about prenatal vitamins, and the use of folic acid, calcium, and iron during pregnancy. Chi-square tests were employed to analyze associations between variables. Results: The findings revealed that 14.55% of participants initiated ANC within the first 8 weeks of pregnancy, with 85.44% starting later. However, the majority 88.78% received prenatal care during pregnancy, regardless of the timing of ANC initiation. Beliefs about prenatal vitamins varied, with 20.08% agreeing that prenatal vitamins were only indicated for malnourished mothers, 72.35% disagreeing, and 7.56% uncertain. Moreover, 51.30% believed ANC should begin before pregnancy, 29.83% after pregnancy confirmation, and 13.57% during the first trimester, with no significant correlation between beliefs and ANC timing. Regarding prenatal care, 95.20% would recommend starting prenatal care with every pregnancy, regardless of the timing of their own ANC initiation. Conclusion: This study offers a comprehensive analysis of factors impacting late ANC contact and inadequate ANC contacts among pregnant Saudi women. These findings contribute to the broader understanding of ANC practices among Saudi women and underscore the importance of considering various determinants for tailored interventions and health education programs. [ABSTRACT FROM AUTHOR]

Approximately two billion individuals, or 26.4% of the global population, live in moderate- to severely food-insecure circumstances. It was discovered that not receiving all recommended antenatal care throughout one's pregnancy is one of the effects of household insecurity. The majority of women in Ethiopia, one of the most food-insecure countries in the world, with 10% of the population facing food poverty, devote more of their time to household duties, making food insecurity in the home the primary effect of poor prenatal care utilization. The main objective this study was to assess the status of household food insecurity among postpartum women at Arba Minch town, southern Ethiopia. A community-based cross-sectional study was conducted among 381 mothers who were enrolled from December 1, 2022, to January 30, 2023. The total sample size was allocated proportionately to the number of postpartum women living in each kebeles taking from the town registry of health extension workers for immunization. Thus, systematic sampling was applied. Kobo Toolbox was used for data collection and cleaning, which was then analyzed using the statistical package of Social Science Version 26 (SPSS). In this study, the prevalence of food insecurity was 30.2% (95% CI 25.5–34.5). The associated factors with household food-insecurity were maternal occupation (AOR = 0.5, 95% CI 0.27, 0.90), late antenatal care initiation (AOR = 3.5, 95% CI 2.13, 5.91), and low monthly income (AOR = 3.1, 95% CI 1.38, 6.93). Food insecurity among postpartum mothers in the study area is high. Families who are severely food insecure require quick assistance to lower poor maternal and neonate's outcomes. Furthermore, enhancing the occupation of mothers is crucial in reducing the morbidities and mortality of food insecure mothers, such as delayed prenatal care services, anemia, low birth weight, and stillbirth. [ABSTRACT FROM AUTHOR]

Background: Provision of effective care to all women and newborns during the perinatal period is a viable strategy for achieving the Sustainable Development Goal 3 targets on reducing maternal and neonatal mortality. This study examined perinatal care (antenatal, intrapartum, postpartum) and its association with perinatal deaths at three district hospitals in Bunyoro region, Uganda. Methods: A cross-sectional study was conducted in which a questionnaire was administered consecutively to 872 postpartum women before discharge who had attended antenatal care and given birth in the study hospitals. Data on care received during antenatal, labour, delivery, and postpartum period, and perinatal outcome were extracted from medical records of the enrolled postnatal women using a pre-tested structured tool. The care received from antenatal to 24 h postpartum period was assessed against the standard protocol of care established by World Health Organization (WHO). Poisson regression was used to assess the association between care received and perinatal death. Results: The mean age of the women was 25 years (standard deviation [SD] 5.95). Few women had their blood tested for hemoglobin levels, HIV, and Syphilis (n = 53, 6.1%); had their urine tested for glucose and proteins (n = 27, 3.1%); undertook an ultrasound scan (n = 262, 30%); and had their maternal status assessed (n = 122, 14%) during antenatal care as well as had their uterus assessed for contraction and bleeding during postpartum care (n = 63, 7.2%). There were 19 perinatal deaths, giving a perinatal mortality rate of 22/1,000 births (95% Confidence interval [CI] 8.1–35.5). Of these 9 (47.4%) were stillbirths while the remaining 10 (52.6%) were early neonatal deaths. In the antenatal phase, only fetal examination was significantly associated with perinatal death (adjusted prevalence ratio [aPR] = 0.22, 95% CI 0.1–0.6). No significant association was found between perinatal deaths and care during labour, delivery, and the early postpartum period. Conclusion: Women did not receive all the required perinatal care during the perinatal period. Perinatal mortality rate in Bunyoro region remains high, although it's lower than the national average. The study shows a reduction in the proportion of perinatal deaths for pregnancies where the mother received fetal monitoring. Strategies focused on strengthened fetal status monitoring such as fetal movement counting methods and fetal heart rate monitoring devices during pregnancy need to be devised to reduce the incidence of perinatal deaths. Findings from the study provide valuable information that would support the strengthening of perinatal care services for improved perinatal outcomes. [ABSTRACT FROM AUTHOR]

Background: The Australian Clinical Practice Guidelines for Pregnancy Care recommend that during the first and subsequent antenatal visits all pregnant women are weighed; advised of recommended gestational weight gain (GWG), dietary intake and physical activity; and offered referrals for additional support if needed. The extent to which these recommendations are implemented and women's acceptability of recommended care is unknown. This study examines women's reported receipt and acceptability of guideline care for GWG, and characteristics associated with receipt of such care and its acceptability. Methods: From September 2018 to February 2019 a telephone survey was undertaken with women who had recently had a baby and received antenatal care from five public maternity services within a health district in Australia. Women self-reported their demographic characteristics, and receipt and acceptability of recommended GWG care. Receipt and acceptability of such care, and their association with the characteristics of women and the maternity service they attended, were examined using descriptive statistics and multivariable logistic regression analyses. Results: Of 514 women, 13.1% (95%CI:10.3–16.5) reported that they received an assessment of weight at both their first and a subsequent antenatal visit, and less than one third (30.0%; 95%CI:26.0-33.9) received advice on their recommended GWG range, dietary intake and physical activity. Just 6.6% (95%CI:4.8–9.1) of women reported receiving all assessment and advice components of recommended antenatal care, and 9.9% (95%CI:7.6–12.8) of women reported being referred for extra support. Women who were younger (OR = 1.13;95%CI:1.05–1.21), identifying as Aboriginal and Torres Strait Islander (OR = 24.54;95%CI:4.98-120.94), had a higher pre-pregnancy BMI (OR = 1.13;95%CI:1.05–1.21), were experiencing their first pregnancy (OR = 3.36;95%CI:1.27–8.86), and lived in a least disadvantaged area (compared to mid-disadvantaged area (OR = 18.5;95%CI:2.6-130.5) and most disadvantaged area (OR = 13.1;95%CI:2.09–82.4)) were more likely to receive recommended assessment and advice. Most Aboriginal (92%) and non-Aboriginal (93%) women agreed that recommended GWG care is acceptable. Conclusion: Most women perceive antenatal care for GWG as recommended by the Clinical Practice Guidelines as acceptable, but did not receive it. When provided, such care is not delivered consistently to all women regardless of their characteristics or those of the maternity service they attend. There is a need for service-wide practice change to increase routine GWG care in pregnancy for all women. [ABSTRACT FROM AUTHOR]

Introduction: Intimate partner violence (IPV) disproportionally affects women compared to men. The impact of IPV is amplified during pregnancy. Screening or enquiry in the antenatal outpatient setting regarding IPV has been fraught with barriers that prevent recognition and the ability to intervene. Aims: The aim of this systematic review was to determine the barriers that face obstetricians/gynaecologists regarding enquiry of IPV in antenatal outpatient settings. The secondary objective was to determine facilitators. Methods: Primary evidence was searched using Ovid MEDLINE, Ovid Maternity and Infant Care, PubMed and Proquest from 1993 to May 2023. The included studies comprised empirical studies published in English language targeting a population of doctors providing antenatal outpatient care. The review was PROSPERO‐registered (CRD42020188994). Independent screening and review was performed by two authors. The findings were analysed thematically. Results: Nine studies addressing barriers and two studies addressing facilitators were included: three focus‐group or semi‐structured interviews, six surveys and two randomised controlled trials. Barriers for providers centred at the system level (time, training), provider level (personal beliefs, cultural bias, experience) and provider‐perceived patient level (fear of offending, patient readiness to disclose). Increased experience and the use of validated tools were strong facilitators. Conclusion: Barriers to screening reflect multi‐level obstruction to the identification of women exposed to IPV. Although the antenatal outpatient clinic setting addresses a particular population vulnerable to IPV, the barriers for obstetricians are not unique. The use of validated cueing tools provides an evidence‐based method to facilitate enquiry of IPV among antenatal women, assisting in identification by clinicians. Together with education and human resources, such aids build capacity in women and obstetric providers. [ABSTRACT FROM AUTHOR]

Objective: To explore women's oral health experiences and barriers to dental care and identify potential strategies to improve oral health during pregnancy. Methods: A qualitative descriptive study design was used. Purposively elected antepartum and postpartum women ≥18 years of age from Tasmania, Australia, were recruited using maximum variation sampling. Semi‐structured interviews were conducted, and all qualitative data were analysed using an inductive thematic approach. Results: Fifteen women were interviewed with a mean ± SD age of 32.3 ± 4.5 years. Three key themes were generated from the data that described women's perceived changes in their oral health during pregnancy; barriers to oral health care during and after pregnancy; and perceived strategies to improve access to care. Most women acknowledged the importance of maintaining good oral health but reported a decline in their oral health status during pregnancy. Women also identified several barriers to dental care, including treatment costs, competing maternal priorities, limited oral health knowledge and negative perceptions towards dentistry. The provision of preventative oral health care by ANC providers was also limited. Community awareness, patient education resources and assessment tools could support the promotion of oral health care. Women also perceived that interprofessional collaboration between antenatal and dental providers played a key role in promoting oral health. Conclusion: This study explored women's varied oral health experiences and perceptions during pregnancy and highlighted critical barriers and enablers to dental care. Policy‐level strategies that promote interprofessional collaboration between antenatal and dental providers and expand dental care access are suggested to overcome barriers to oral health for women during pregnancy. [ABSTRACT FROM AUTHOR]

Background: Physiological and hormonal changes during pregnancy can alter the sleep patterns of the pregnant women and were said to be precursor for the development of obstructive sleep apnea (OSA) and complication of pre-existing OSA. Developing country like India has no health cost distribution for the treatment, as this condition's treatment trends absorbs 65-82% of all health cost. There is oblivious state among clinicians and patients, self-reporting of the symptoms are poor which, in turn, results to upshot underdiagnoses of OSA among southern Indian population. Aims and Objectives: The aim of the study is to screen the prevalence of OSA among the southern Indian pregnant women attending antenatal care and to evaluate its predisposing factors. Materials and Methods: We enrolled 305 pregnant women according to our study selection criteria, attended antenatal care at ACS medical college and hospitals from Chennai. On face-to-face basis, berlin questionnaire screening was done. With a brief interview, sociodemographic details, medical records and laboratory parameters were obtained. To cluster the risk of OSA prevalence, percentage was estimated using frequency distribution. Chi-square analysis was done to obtain significant relationship between contributing factors and OSA symptoms. Statistical testing was done with SPSS software version 21. Results: Among 305 pregnant women, 31.8% (97) were shown to have high-risk OSA and 68.2% (208) low-risk OSA. Across the trimester, highrisk OSA were noted among 8.2% (25), 11.1% (34), and 15.4% (48) at first, second, and third trimester, respectively. Age, body mass index, occupation, neck circumference, multiple pregnancy, and presence of conditions such as gestational hypertension, chronic hypertension, adenoids, mallampatti grade, nasal congestion, and family history of OSA can be the predisposing factors which could influence the OSA symptoms. Conclusion: The future investigations should rely on the analysis of the fetal outcomes after proper diagnosis of OSA. Furthermore, independent predictive values of physical signs, history, risk factors, and mechanisms behind the progression of OSA should be studied well. Region and area specific difference of risk of OSA to identify disparities and to promote decentralization of sleep care could be done. [ABSTRACT FROM AUTHOR]

Background: Anxiety disorders in pregnancy are common and represent a global concern. However, data regarding the magnitude of anxiety among pregnant women in Uganda are limited, and yet, these data could pave way for implementing effective mitigation measures. We determined the prevalence of anxiety disorders and associated factors among pregnant women at Mulago Hospital Uganda. Methods: A cross-sectional study was conducted among pregnant women attending antenatal care clinic at Mulago Hospital between September and November 2015. Systematic sampling was used to enroll eligible women. An interviewer-administered demographic questionnaire and the Hamilton Anxiety Rating Scale for Antenatal Anxiety (HAMA-A) scale were used to assess demographic features and anxiety, respectively. Women with HAMA-A score ≥ 17 were considered to have anxiety disorder. Factors associated with anxiety disorders were determined using multivariate logistic regression. Results: A total of 501 pregnant women were enrolled into the study; the prevalence of anxiety disorders was 13% (n=65; 95% CI: 9.8– 15.7%). Factors that were significantly associated with anxiety disorders were low income of the participants (adjusted odds ratio [AOR]=2.65, 95% CI: 1.16– 6.06), bad relationship with spouse (AOR = 2.50, 95% CI: 1.01– 5.82) and history of hypertension in previous pregnancy (AOR = 4.17, 95% CI: 1.68– 10.37). Conclusion: Approximately one in ten women surveyed exhibited anxiety disorders. Anxiety disorders were associated with low-income levels, bad spousal relationships, and a history of hypertension during previous pregnancies. Multidisciplinary approaches that integrate mental health support, social services, and partner involvement may help address anxiety disorders in pregnancy and contribute to improved maternal and child outcomes. [ABSTRACT FROM AUTHOR]

Objective: Antenatal visits play a very important role to diagnose and manage pregnancy related health issues. This study was an attempt to identify the reasons that increase the risk of postpartum acute kidney Injury with special focus on antenatal care. Methods: We analyzed 110 patients in Nephrology and Gynaecology wards in Lahore General Hospital. Out of these 40 had Postpartum Acute Kidney Injury and 70 patients did not have it. Questionnaire regarding aspects of antenatal care (demographics, timing and number of antenatal visits) was filled by the patient or immediate family members. Results: Mean age of the 110 patients was 26.45 years. Mean Duration of pregnancy in the control group was 36.12 weeks and in cases it was 31.62 weeks. Out of 110 patients, 36(32.72%) patients did not have any antenatal visit while 62(56.3%) patients had more than five visits. Out of the 40 Postpartum Acute Kidney Injury patients, 23(57.5%) patients did not get any antenatal care. Out of 70 patients without Postpartum Acute Kidney Injury, 13 did not have any antenatal care. There were 19 patients who did not have booked visits because of financial Issues, followed by lack of awareness in 12 patients, distance issues for three patients and lack of family support for two patients. Conclusion: Patients who did not have antenatal care were at an increased risk of developing PPAKI. Financial issues and lack of awareness were the most common risk factors for compromised antenatal care. [ABSTRACT FROM AUTHOR]

Introduction: Longitudinal client tracking systems with digital health interventions are recommended for implementation in resource-limited settings but lack evidence of benefits, harms, and implementation. In the eRegMat cluster-randomized controlled trial, we aimed to assess the effectiveness of an eRegistry versus an unshared digital client record. Methods: Fifty-nine primary health care facilities in Matlab, Bangladesh were randomized with a 1:1 allocation ratio to receive an eRegistry (intervention, 30 health facilities) with decision support, feedback dashboards and targeted client communication, or an unshared digital client record without digital health interventions (control, 29 health facilities). We assessed timely antenatal care attendance, quality of care, and health outcomes. Outcome data were captured in the eRegistry, or unshared digital client record used by health workers, and through a postpartum household survey. We estimated adjusted relative risks (ARRs) following the intention-to-treat principle and adjusted for cluster randomization. Results: From October 2018 to June 2020, 3023 pregnant women were enrolled in the intervention and 2746 in the control groups through community and facility registrations. Intervention and control groups did not differ for the primary outcomes: timely attendance at eligible antenatal care visits (42.5% vs. 40.3%, ARR 0.96, 95% CI 0.89–1.05, p-value 0.4) and hypertension screening and management (95.1% vs. 94.7%, ARR 1.00, 95% CI 0.96–1.03, p-value 0.8). The secondary outcome of perinatal mortality and severe perinatal morbidities was lower in the intervention (14.6%) compared to the control group (15%) (ARR 0.74, 95% CI 0.58–0.96, p-value 0.02), with the change mostly attributed to morbidity outcomes. Conclusion: Due to technical and implementation challenges we were unable to estimate the effect of the intervention with sufficient precision. Challenges included delays in rollout of the digital health interventions and outcome data collection, existence of parallel documentation systems on paper and digital and the COVID-19 pandemic. Given these methodological constraints, we are unable to draw definitive interpretations of trial results. Trial registration: ISRCTN Registry ISRCTN69491836; https://www.isrctn.com/ISRCTN69491836. Date of registration 06.12.2018. [ABSTRACT FROM AUTHOR]

In the United Kingdom, roughly 1 in 250 babies are stillborn each year. Most women who experience stillbirth become pregnant again – 80% within a year of loss. Presently, obstetric-led care is recommended; though there is a growing body of evidence to support provision of specialist services. The Rainbow Clinic is a specialist antenatal service providing care for pregnancies after loss incorporating clinical and psychological care. This study aimed to assess patient experience at the Rainbow Clinic and identify areas for clinical improvement. A 13-item questionnaire was distributed to pregnant women who attended the Rainbow Clinics at the Oxford Road and Wythenshawe sites of Saint Mary's Hospital, Manchester, UK between July 2016 and June 2021. Descriptive statistics and unpaired t-test were used for quantitative data and summative content analysis for qualitative data. Four-hundred and fifty-six women completed the questionnaire. The mean patient experience score per quarter was stable with an average of 21.1 (± 3.0) for the five years, with a maximum attainable score of 25. The COVID-19 pandemic had no effect on patient experience at the Rainbow Clinic (pre-pandemic vs. during-pandemic: mean 21.2 v 21.3; p = 0.75). Free-text responses demonstrated women felt positively about the antenatal care received. Identified areas for improvement included "more awareness of the [Rainbow] sticker" to ensure women with previous loss are identified; increased publicity of the Rainbow Clinic services; developing more clinics at different locations to improve accessibility; and continuing specialist input into intrapartum care. Specialist antenatal care provided by the Rainbow Clinic was rated as of a high standard. Potential future improvements include sticker alterations (or other mechanisms to identify women who have experienced a previous loss) and develop increased awareness of the clinic in other institutions. [ABSTRACT FROM AUTHOR]

Background: Measuring socioeconomic inequalities in healthcare usage represents a critical step towards promoting health equity, in alignment with the principles of universal health coverage and the United Nations' Sustainable Development Goals. In this study, we assessed the socioeconomic inequalities in HIV testing during antenatal care (ANC) in sub-Saharan Africa. Methods: Sub-Saharan Africa was the focus of this study. Benin, Burundi, Cameroon, Ethiopia, Gambia, Guinea, Liberia, Malawi, Mali, Mauritania, Mozambique, Rwanda, Sierra Leone, Uganda, Zambia, and Zimbabwe were the countries included in the study. This study used current Demographic and Health Surveys data spanning from 2015 to 2022. A total of 70,028 women who tested for HIV as part of antenatal contacts formed the sample for analysis. We utilized the standard concentration index and curve to understand the socioeconomic inequalities in HIV testing during antenatal care among women. Additionally, a decomposition analysis of the concentration index was ran to ascertain the contributions of each factor to the inequality. Results: Overall, 73.9% of women in sub-Saharan Africa tested for HIV during ANC. The countries with the highest proportions were Malawi, Rwanda, Zambia, and Zimbabwe. Mali Benin, Guinea, Mali, and Mauritania were the countries with the lowest proportions of HIV testing. Being among the richer [AOR 1.10, 95% CI: 1.02,1.18] and richest [AOR 1.41, 95% CI:1.30, 1.54] wealth quintiles increased the odds of HIV testing during ANC. The concentration value of 0.03 and the curve show that HIV testing is more concentrated among women in the highest wealth quintile. Hence, wealthy women are advantaged in terms of HIV testing. As the model's residual value is negative (-0.057), the model overestimates the level of inequality in the outcome variable (HIV during ANC), which means that the model's explanatory factors can account for higher concentration than is the case. Conclusion: We found that there is substantial wealth index-related inequalities in HIV testing, with women of the poorest wealth index disadvantaged in relation to the HIV testing. This emphasizes the necessity for sub-Saharan Africa public health programs to think about concentrating their limited resources on focused initiatives to grasp women from these socioeconomic circumstances. To increase women's access to HIV testing, maternal and child health programs in sub-Saharan Africa should attempt to minimize female illiteracy and poverty. Consequently, health education may be required to provide women with comprehensive HIV knowledge and decrease the number of lost opportunities for women to get tested for HIV. Given the link between knowledge of HIV and HIV testing, it is important to focus on community education and sensitization about HIV and the need to know one's status. [ABSTRACT FROM AUTHOR]

Background: This study explores the landscape of maternal health and its impact on neonatal outcomes, focusing on the prevalence of diverse pregnancy-related complications. Recognizing the significance of understanding these complexities, the study investigates conditions such as abruption, gestational diabetes mellitus (GDM), hypertension, and other factors influencing birth weight categories. Objective: To contribute nuanced insights to maternal and neonatal healthcare practices. Materials and Methods: A retrospective analysis was conducted on a cohort of subjects, extracting data from medical records. The study encompassed various pregnancy-related complications, including abruption, GDM, hypertensive disorders, fetal growth restrictions, and other maternal conditions. Statistical analyses, including percentages and prevalence rates, were employed to elucidate the distribution of these complications within the studied population. Results: The findings reveal a diverse spectrum of maternal health conditions. Notable observations include the prevalence of GDM (8.2%), hypertensive disorders (6.6%), and post-term pregnancies (11.5%). Additionally, conditions such as abruption, fetal growth restriction, and preterm births exhibited varying frequencies. Rhnegative pregnancies accounted for 9.8%, emphasizing the multifaceted nature of maternal health complexities within the studied population. Conclusion: This study provides a comprehensive overview of pregnancy-related complications and their prevalence within the studied cohort. The findings underscore the need for personalized antenatal care strategies, early anomaly detection, and focused interventions to optimize maternal and neonatal outcomes. Recognizing the intricate relationships between maternal health conditions and birth outcomes is crucial for informing clinical decisionmaking and enhancing public health initiatives. [ABSTRACT FROM AUTHOR]

Background: Social determinants of health are important contributors to maternal and child health outcomes. Limited existing research examines the relationship between housing instability during pregnancy and perinatal care utilization. Our objective was to evaluate whether antenatal housing instability is associated with differences in perinatal care utilization and outcomes. Materials and Methods: Participants who were surveyed during their postpartum hospitalization were considered to have experienced housing instability if they answered affirmatively to at least one of six screening items. The primary outcome was adequacy of prenatal care measured by the Adequacy of Prenatal Care Utilization index. Maternal, neonatal, and postpartum outcomes, including utilization and breastfeeding, were also collected as secondary outcomes. Multivariable logistic regression models were adjusted for sociodemographic and clinical covariates. Results: In this cohort (N = 490), 11.2% (N = 55) experienced housing instability during pregnancy. Participants with unstable housing were more likely to have inadequate prenatal care (17.3% vs. 3.9%; odds ratio [OR] 5.11, 95% confidence interval [CI] 2.15–12.14, p < 0.001), but findings were not significant after adjustment (aOR 1.72, 95% CI 0.55–5.41, p = 0.35). Similarly, postpartum visit attendance was lower for individuals with unstable housing (79.6% vs. 91.2%), but there was no difference in the odds of the postpartum visit attendance after adjustment (OR 0.69, 95% CI 0.29–1.66, p = 0.14). Conclusions: There were no statistically significant association with the maternal, neonatal, and other postpartum secondary outcomes. Housing instability appears to be a risk marker that is related to other social determinants of health. Given the range of housing instability experiences, future research must account for specific types and degrees of housing instability and their potential perinatal consequences. [ABSTRACT FROM AUTHOR]

Background: Gestational diabetes mellitus (GDM) is an increasing public health problem worldwide. Measuring the level of knowledge in a population at high risk for GDM will highlight the gaps and help in designing appropriate interventions. The objective of this study was to measure the knowledge about GDM and to identify the factors associated with it among pregnant women in Riyadh city, Saudi Arabia. Methodology: A cross-sectional study was conducted with pregnant women seeking antenatal care services in two of the public sector tertiary care hospitals in Riyadh city. The study was performed using a self-administrated predesigned questionnaire. Collected data were analyzed using SPSS program. Results: More than 40% of the participants had poor knowledge about GDM complications, diagnosis and management. Women with lack of exercise [adjusted odds ratio 3.3 (95% CI 1.8, 6.1)]; having past histroy of GDM [3.2 (1.8, 5.7); primigravida [2.9 (1.6, 5.1)]; information on GDM received from doctors [2.0 (1.2, 3.4)] and those with low education level [1.8 (1.1, 2.9)] were more likely to have poor knowledge about GDM. Whereas, women with positive family history were 60 times more likely to have good knowledge about GDM. Conclusion: Primigravida mothers and those with low education level should receive specific information and awareness regarding GDM. Healthy lifestyle is important for the prevention and improvement in the diagnosis and management of GDM among pregnant women in Riyadh. [ABSTRACT FROM AUTHOR]

• Government health care services are the primary source of maternal care for the tribes (indigenous communities). • Particularly vulnerable tribal groups are at risk of foregoing antenatal care and are more likely to give childbirth at home. • Health workers' home visits and advice significantly and positively influence maternal healthcare-seeking behaviour. • Maternal education and having all-weather roads are crucial determinants for institutional childbirths. • Certain socio-cultural practices (early marriages leading to teenage pregnancies) need to be addressed. To report the utilisation of maternal healthcare services and factors associated with adequate antenatal care and institutional childbirths among mothers in the tribal communities from nine districts in India. Cross-sectional data were collected from 2636 tribal women who had a childbirth experience in the past 12 months. Socio-demographic, maternal healthcare services and health system-related details were collected. Multiple logistic regression analyses were done to identify factors associated with adequate antenatal care (receiving at least four antenatal care visits, the first visit being in the first trimester and receiving a minimum of 100 iron-folic acid tablets) and institutional childbirth (mother giving birth in a health facility). Only 23% of the mothers received adequate antenatal care. 82% were institutional childbirths. The logistic regression revealed that particularly vulnerable tribal groups (PVTGs), those lacking all-weather roads, and women of advanced age were at risk of inadequate antenatal care. Mother's education, health worker's home visits during pregnancy and reception of advice on antenatal care were significantly associated with the reception of adequate antenatal care. Having all-weather roads, and education of the mother and head of the household were positively associated with institutional childbirths, whereas PVTGs, children of birth order three or above, and working mothers were more likely to give childbirth at home. PVTGs are at risk of foregoing adequate antenatal care and are more likely to give childbirth at home. Having all-weather roads is a strong correlate of adequate maternal care. Outreach activities by the health workers are to be strengthened as they are positively and significantly associated with the reception of adequate antenatal care. Investing in education and other social determinants and addressing certain socio-cultural practices is important to improve maternal health. [ABSTRACT FROM AUTHOR]

Background: Antenatal healthcare (ANC) reduces maternal and neonatal deaths in low-middle-income countries. Satisfaction with ANC services and perception of quality of care are critical determinants of service utilization. The study aimed to assess pregnant women's satisfaction with ANC and identify sociodemographic factors associated with satisfaction and their continued willingness to use or recommend the facility to relatives or friends, in Lusaka district, Zambia. Methods: This was a cross-sectional study involving 499 pregnant women in Lusaka district. A combination of stratified, multistage, and systematic sampling procedures was used in selecting health facilities and pregnant women. This allowed the researcher to assess exposure and status simultaneously among individuals of interest in a population. Structured survey instruments and face-face-interview techniques were used in collecting data among pregnant women who were receiving ANC in selected health facilities. Results: Overall, the proportion of pregnant women who were fully satisfied with ANC was 58.9% (n = 292). Pregnant women's satisfaction score ranged from physical aspects (40.9 - 58.3%), interpersonal aspects (54.3 - 57.9%) to technical aspects of care (46.9 - 58.7%). Husbands' employment status (OR = 0.611, 95%CI = 0.413 – 0.903, p = 0.013), monthly household income level of > 3000 - ≤6000 Kwacha (OR = 0.480, 95%CI = 0.243 – 0.948, p = 0.035 were significantly associated with the interpersonal aspects and the physical aspects of care, respectively. Besides, pregnant women who were in their third trimester (above 33 weeks), significantly predicted satisfaction with the physical environment of antenatal care (OR = 3.932, 95%CI = 1.349 – 11.466, p = 0.012). In terms of the type of health facility, women who utilized ANC from Mtendere (OR = 0.236, 95% CI = 0.093 – 0.595, p = 0.002) and N'gombe (OR = 0.179, 95% CI = 0.064 – 0.504, p = 0.001) clinics were less satisfied with the physical environment of care. Place of residence and educational attainment showed significant association with 'willingness to return'. N'gombe clinic (n = 48, 77.4%) received the lowest consideration for 'future care'. Conclusion: Drawing on Donabedian framework on assessing quality of healthcare, we posit that pregnant women's satisfaction with the quality of antenatal care was low due to concerns about the physical environment of health facilities, the interpersonal relationships between providers and pregnant women as well as the technical aspects of care. All these accounted for pregnant women's dissatisfaction with the quality of care, and the indication of unwillingness to return or recommend the health facilities to colleagues. Consistent with Donabedian framework, we suggest that the codes and ethics of healthcare must be upheld. We also call for policy initiatives to reshape the physical condition of ANC clinics and to reinforce healthcare providers' focus on the 'structures' and the 'processes' relevant to care in addition to the 'outcomes'. [ABSTRACT FROM AUTHOR]