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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: The estimated burden of maternal morbidities in lower-income countries, such as Madagascar, is high. However, there is still a lack of data on maternal morbidities, in part due to an absence of standardized assessment tools. This cross-sectional study aims to report maternal morbidities among 1015 women in the district of Ambanja, Madagascar, and to describe the advantages and limitations of a mHealth system. Methods: Data were collected using the PANDA (pregnancy and newborn diagnosis assessment) system, an mHealth device that incorporates the WHO recommendations for antenatal care (ANC). Data, including personal and medical information, but also clinical data such as hypertension, anemia or HIV were collected from more than 1000 women attending ANC. Results: A total of 1015 pregnant women were recruited from January 2015 to August 2018. The average age was 24.6 years old, and most women were married (82.3%). The majority lived in urban areas and were unemployed. Prevalence of hypertension and gestational diabetes was relatively low (4% vs 2.2%). Malaria infection was diagnosed in 2.2% and HIV was diagnosed in 1.2% of pregnant women. The most common morbidity was anemia (68.4%) and the only significant factor associated was being single compared to being married (OR 1.68, 95% CI 1.05– 2.70, p-value 0.032). Discussion: The prevalence of anemia in our study population was much higher than previously reported in Sub-Saharan Africa. This finding highlights the need for regular iron supplementation during pregnancy, especially in vulnerable (eg, single) women. The PANDA mHealth system provides unique opportunities due to its standardization of ANC and creation of a digital database accessible from a distance. However, one of the main challenges was that even a mHealth system such as the PANDA remains dependent on the local procurement chain. Therefore, future studies need to access opportunities of mHealth systems to support health service delivery. Trial Registration: Registered on ISRCTN on 14th October 2015, number ISRCTN18270380. Retrospectively registered. [ABSTRACT FROM AUTHOR]

Background: Despite the importance of postnatal care (PNC) in maternal and newborn health, however, such services have been underutilized in many resource-constrained settings including The Gambia. The objective of this study was to determine the coverage and factors of PNC in The Gambia. Methods: The 2018 data from The Gambia Multiple Indicators Cluster Survey (MICS) were analyzed. Data from 9205 women with ages 15– 49 years, who also have given birth, were extracted for the analysis. Percentages and Chi-square tests were used. In addition, multivariable logistic regression model was used to calculate the adjusted odds ratios (with corresponding 95% CI). The level of significance was set at p< 0.05. Results: The prevalence of PNC was 22.4% and 26.7% for women and children, respectively. Local government area (LGA) was associated with PNC for women and children alike. Furthermore, ethnicity was associated with PNC among women in The Gambia. Women who listened to radio almost every day had 1.51 increase in the odds of PNC (OR= 1.51; 95% CI: 1.15, 1.98) and 1.30 increase in the odds of PNC for children (OR= 1.30; 95% CI: 1.01, 1.67), respectively, when compared with women who do not listen to radio. Women who initiated antenatal care (ANC) at second or third trimester (late booking) had a 22% reduction in the odds of PNC (OR= 0.78; 95% CI: 0.64, 0.94), when compared with women who booked at first trimester. Conclusion: The findings showed that geographical locations, ethnicity, use of radio, and timing to antenatal care initiation were associated with PNC. Women's enlightenment and early ANC programs can be designed to improve PNC coverage. [ABSTRACT FROM AUTHOR]

Introduction: While Nigeria accounts for only 2% of the world population, it regrettably shares 14% of global maternal death burden. Whether its reported increase in antenatal care utilization is accompanied by increased use of skilled birth attendants (SBAs) is not known. This study assessed trends in utilization of SBAs in Nigeria between 1990 and 2013 and identified its determinants. Methods: Data from four consecutive Nigerian Demographic and Health Survey reports between 1990 and 2013 were pooled. We used basic descriptive statistics, test of association, and logistic regression to assess the prevalence, relative change, and determinants of SBA use at 5% significance level. Sample weights were applied, and adjustment was made for survey design and sampling errors. Results: Nearly half (46.7%) of the respondents were aged 25-34 years, while half (50.3%) of the respondents had no formal education. The prevalence of SBA use increased only marginally across the years and characteristics studied, from 32.4% in 1990 to 38.5% in 2013, an insignificant 6% increase. Educated women used SBA more than women with no education (92.4% vs 13.1%), and their odds ratio of using SBA were thrice that of uneducated women (odds ratio =3.09, 95% confidence interval =2.17-4.38). Women involved in decisions regarding their use of health facility were 12% more likely to use SBAs than others who do not. Educational attainment, religion, tribe, rural/urban residence, and zone of residence were significant to the use of SBA. Conclusion: The use of SBA was very low throughout the study period, barely at one third usage with insignificant changes over the studied period. Women empowerment, including decision-making power and residence, were the strongest determinants of SBA use. To overturn poor child and maternal health outcomes in Nigeria through SBA use, efforts should be targeted at educating girls, sexual and reproductive health education, and accessible and improved health care facility services. [ABSTRACT FROM AUTHOR]

Background: Child and maternal mortality and morbidity remain among the top global health challenges despite various efforts and multitude of resources directed to improving this situation over time. This study assessed trend of the timings of first antenatal care (ANC) visit in Nigeria and also identified the risk factors associated with it. Methods: The data obtained from three consecutive Nigerian Demographic and Health Surveys in 2003, 2008, and 2013 were pooled. We focused on the ANC attendance history during the current pregnancies or the last pregnancies within 5 years preceding the survey irrespective of how the pregnancy ended. The gestational age at time of first ANC visit was computed as the survival time, while others who did not attend ANC were censored. Basic descriptive statistics and survival analysis methods were used to analyze the data. Results: A total of 45,690 pregnancies were studied, of which 70% were from rural areas. Mothers were mostly (45%) aged 25-34 years and 47.1% had no formal education, while only 37.9% were involved in decisions on the use of health care facility. Prevalence of ANC use was 60.5% in 2008 and 65.8% in both 2003 and 2013. Less than one-third (32.3%) of the women accessed ANC within first 3 months of pregnancy, with highest rate (41.7%) among women with higher education and those from North Central Nigeria (42.7%). The hazard of the timing of first ANC visit was higher in years 2003 and 2013 than in 2008. Conclusion: Initiation of ANC visit in Nigeria is generally late with most women making first visit during second trimester, with significant variations across the years studied. The increase in coverage of ANC recorded in 2003 and 2013 was not accompanied by earlier commencement of ANC visit. Maternal health stakeholders should do more to ensure that all pregnant women start ANC visit earlier. [ABSTRACT FROM AUTHOR]

Background: Despite considerable efforts to reduce the maternal mortality ratio, numerous pregnant women continue to die in many developing countries, including Nigeria. We conducted a study to determine the incidence and causes of maternal mortality over an 8-month period in a rural-based secondary health facility located in Jahun, northern Nigeria. Methods: A retrospective observational study was performed in a 41-bed obstetric ward. From October 2010 to May 2011, demographic data, obstetric characteristics, and outcome were collected from all pregnant women admitted. The total number of live births during the study period was recorded in order to calculate the maternal mortality ratio. Results: There were 2,177 deliveries and 39 maternal deaths during the study period, with a maternal mortality ratio of 1,791/100,000 live births. The most common causes of maternal mortality were hemorrhage (26%), puerperal sepsis (19%), and obstructed labor (5%). No significant difference (P = 0.07) in mean time to reach the hospital was noted between fatal cases (1.9 hours, 95% confidence interval [CI] 1.1-2.6) and nonfatal cases (1.4 hours, 95% CI 1.4-1.5). Two hundred and sixty-six women were admitted presenting with stillbirth. Maternal mortality was higher for unbooked patients than for booked patients (odds ratio 5.1, 95% CI 3.5-6.2, P < 0.0001). The neonatal mortality rate was calculated at 46/1,000 live births. The main primary causes of neonatal deaths were prematurity (44%) and birth asphyxia (22%). Conclusion: Maternal and neonatal mortality remains unacceptably high in this setting. Reducing unbooked emergencies should be a priority with continuous programs including orthodox practices in order to meet the fifth Millennium Development Goal. [ABSTRACT FROM AUTHOR]