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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: 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]

Background: Antenatal care (ANC) is crucial for reducing maternal morbidity and mortality, especially in low-resource settings. During antenatal care, women are provided with resources for enhancing their dietary diversity, like nutrition education and counseling. Improved nutrition knowledge influences positive nutritional behavior change, like women's improved dietary diversity, which may increase the likelihood of a healthier pregnancy and delivery experience. Objective: This study aim was to assess dietary diversity and associated factors among pregnant women attending antenatal care in the Coast region of Tanzania. Methods: The descriptive cross-sectional study design was used to assess dietary diversity and associated factors among 338 pregnant women. A semi-structured questionnaire collected information from pregnant women on social demographic characteristics, nutrition knowledge and dietary diversity. Women were classified as having a varied diet if they had consumed at least five of the ten food groups over the previous twenty-four hours. Multivariable logistic regression analyses were used to identify predictors of dietary diversity in pregnant women. Results: Only 28% (95% CI: 23.5–33.1) (n = 95) of pregnant women met the minimum dietary diversity, and 18% (95% CI: 13.8–21.9) (n = 59) were considered to have a high level of nutrition knowledge. Living near a health facility (AOR = 1.77, CI 1.02, 3.06), having high nutrition knowledge (AOR = 2.58, 95% CI: 1.36, 4.89), and being pregnant for the first time (AOR = 2.44, 95% CI: 1.09, 5.44) were associated with adequate dietary diversity. Conclusion: Pregnant women in the study were found to have low knowledge about nutrition and inadequate dietary diversity intake. The findings underscore the need to improve nutrition knowledge provision in antenatal clinics by emphasizing the importance of a diversified and high-quality diet. Healthcare providers in antenatal care clinics should consistently provide nutrition education and counseling to pregnant women and promote their diversified food consumption. Such knowledge may eventually promote healthier pregnancy and child development by curbing the nutritional deficiencies experienced during pregnancy. [ABSTRACT FROM AUTHOR]

Introduction: Eclampsia, characterized by generalized convulsions associated with preeclampsia during pregnancy, labor, or within 7 days post-delivery, remains a significant challenge in maternal healthcare. This study explores the incidence, management, and maternal characteristics of eclampsia, emphasizing the importance of early diagnosis and timely intervention. Materials and Methods: A two-year prospective study was conducted at a Tertiary Care Teaching Hospital, recruiting 821 pregnant mothers with eclampsia. Patients with other causes of pregnancy-related convulsions were excluded. Data on convulsion episodes, treatment modalities, and hypertension control were analyzed. Results: The majority (66%) experienced 2 to 5 convulsion episodes, with a range from 1 to 40. Patients with more than 10 convulsions showed improved outcomes after the Loading Dose of MgSO4. Hypertension control solely through delivery was observed in 29% of cases, with additional administration of Calcigard in some instances. Conclusion: Eclampsia, more prevalent in young primigravida patients, underscores the need for enhanced antenatal care surveillance. Early detection of pre-eclampsia through regular blood pressure monitoring and urine protein screening is crucial. Sensitization of healthcare providers at grassroots levels is imperative for ensuring timely diagnosis and effective management, thus positively impacting maternal and child care outcomes. [ABSTRACT FROM AUTHOR]

The Internet of Things (IoT) has positioned itself globally as a dominant force in the technology sector. IoT, a technology based on interconnected devices, has found applications in various research areas, including healthcare. Embedded devices and wearable technologies powered by IoT have been shown to be effective in patient monitoring and management systems, with a particular focus on pregnant women. This study provides a comprehensive systematic review of the literature on IoT architectures, systems, models and devices used to monitor and manage complications during pregnancy, postpartum and neonatal care. The study identifies emerging research trends and highlights existing research challenges and gaps, offering insights to improve the well-being of pregnant women at a critical moment in their lives. The literature review and discussions presented here serve as valuable resources for stakeholders in this field and pave the way for new and effective paradigms. Additionally, we outline a future research scope discussion for the benefit of researchers and healthcare professionals. [ABSTRACT FROM AUTHOR]

Background: For decades, antenatal care in high-resource settings has involved 12–14 face-to-face visits across pregnancy. The COVID-19 pandemic forced many care providers to rapidly embrace telehealth to reduce face-to-face visits. Here we review recent advances in telehealth used to provide antenatal care. Main body: We conducted a narrative review examining the impact of telehealth on obstetric care. Two broad types of telehealth are used in antenatal care. The first is real-time telehealth, where consultations are done virtually instead of face-to-face. The second is remote monitoring, where in-clinic physical examinations are replaced with at-home alternatives. These can include blood pressure monitoring, fetal heart rate monitoring, and emerging technologies such as tele-ultrasound. Large cohort studies conducted during the pandemic era have shown that telehealth appears not to have increased adverse clinical outcomes for mothers or babies. However, further studies may be required to confidently conclude rare outcomes are unchanged, such as maternal mortality, serious morbidity, or stillbirth. Health economic studies suggest telehealth has the potential to reduce the financial cost of care provision. Telehealth in antenatal care seems to be acceptable to both pregnant women and healthcare providers. Conclusion: Adoption of telehealth technologies may improve the antenatal care experience for women and reduce healthcare expenditure without adversely impacting health outcomes for the mother or baby. More studies are warranted to confirm telehealth does not alter the risk of rare outcomes such as maternal or neonatal mortality. [ABSTRACT FROM AUTHOR]

Background: Suriname is a uppermiddle-income country with a relatively high prevalence of preventable pregnancy complications. Access to and usage of high-quality maternity care services are lacking. The implementation of group care (GC) may yield maternal and child health improvements. However, before introducing a complex intervention it is pivotal to develop an understanding of the local context to inform the implementation process. Methods: A context analysis was conducted to identify local needs toward maternity and postnatal care services, and to assess contextual factor relevant to implementability of GC. During a Rapid Qualitative Inquiry, 63 online and face-to-face semi-structured interviews were held with parents, community members, on-and off-site healthcare professionals, policy makers, and one focus group with parents was conducted. Audio recordings were transcribed in verbatim and analysed using thematic analysis and Framework Method. The Consolidated Framework for Implementation Research served as a base for the coding tree, which was complemented with inductively derived codes. Results: Ten themes related to implementability, one theme related to sustainability, and seven themes related to reaching and participation of the target population in GC were identified. Factors related to health care professionals (e.g., workload, compatibility, ownership, role clarity), to GC, to recipients and to planning impact the implementability of GC, while sustainability is in particular hampered by sparse financial and human resources. Reach affects both implementability and sustainability. Yet, outer setting and attitudinal barriers of health professionals will likely affect reach. Conclusions: Multi-layered contextual factors impact not only implementability and sustainability of GC, but also reach of parents. We advise future researchers and implementors of GC to investigate not only determinants for implementability and sustainability, but also those factors that may hamper, or facilitate up-take. Practical, attitudinal and cultural barriers to GC participation need to be examined. Themes identified in this study will inspire the development of adaptations and implementation strategies at a later stage. [ABSTRACT FROM AUTHOR]

Background: Maternal vaccinations against Influenza, Pertussis, and Covid-19 are recommended in the UK, and vaccines against further infections may become available soon. However, many pregnant women, especially in socially and ethnically diverse areas, have low vaccine uptake. Qualitative studies on the reasons and possible solutions are needed that are inclusive of disadvantaged and minority ethnic groups. We therefore aimed to understand the complex interplay between structural and behavioural factors contributing to the low maternal vaccine uptake in socially and ethnically diverse areas in London in the Covid-19 context. Methods: In 2022, we conducted semi-structured interviews and a focus group discussion among a purposive sample of 38 pregnant/recently pregnant women and 20 health service providers, including 12 midwives. Participants were recruited in ethnically diverse London boroughs. We followed a critical realist paradigm and used a thematic analysis approach. Results: The sample included participants who took all, some or none of the maternal vaccines, with some participants unsure whether they had taken or been offered the vaccines. Decision-making was passive or active, with the expectation for pregnant women to do their 'own research'. Participants described various individual, social and contextual influences on their decision-making as they navigated the antenatal care system. Missing or conflicting information from providers meant knowledge gaps were sometimes filled with misinformation from unreliable sources that increased uncertainties and mistrust. Both pregnant women and providers described structural and organisational factors that hindered access to information and vaccinations, including lack of training, time and resources, and shortcomings of health information systems and apps. Some participants described factors that facilitated vaccination uptake and many made recommendations for improvements. Conclusions: Our study showed how structural and organisational factors can compound uncertainties around maternal vaccination among socially and ethnically diverse populations. Results highlight the need for more reliable resources, streamlined workflows, improved electronic information systems and training in their use. Roles and responsibilities should be clarified with potential greater involvement of nurses and pharmacists in vaccine provision. Education and communication should consider individual (language/digital) skills and needs for information and reassurance. Further research is needed to co-produce solutions with service users and providers. [ABSTRACT FROM AUTHOR]

Background: In South Asia, roughly half of women attend at least four antenatal care visits with skilled health personnel, the minimum number recommended by the World Health Organization for optimal birth outcomes. A much greater proportion of women attend at least one antenatal care visit, suggesting that a key challenge is ensuring that women initiate antenatal care early in pregnancy and continue to attend after their first visit. One critical barrier to antenatal care attendance may be that women do not have sufficient power in their relationships, households, or communities to attend antenatal care when they want to. The main goals of this paper were to 1) understand the potential effects of intervening on direct measures of women's empowerment—including household decision making, freedom of movement, and control over assets—on antenatal care attendance in a rural population of women in Bangladesh, and 2) examine whether differential associations exist across strata of socioeconomic status. Methods: We analyzed data on 1609 mothers with children under 24 months old in rural Bangladesh and employed targeted maximum likelihood estimation with ensemble machine learning to estimate population average treatment effects. Results: Greater women's empowerment was associated with an increased number of antenatal care visits. Specifically, among women who attended at least one antenatal care visit, having high empowerment was associated with a greater probability of ≥ 4 antenatal care visits, both in comparison to low empowerment (15.2 pp, 95% CI: 6.0, 24.4) and medium empowerment (9.1 pp, 95% CI: 2.5, 15.7). The subscales of women's empowerment driving the associations were women's decision-making power and control over assets. We found that greater women's empowerment is associated with more antenatal care visits regardless of socioeconomic status. Conclusions: Empowerment-based interventions, particularly those targeting women's involvement in household decisions and/or facilitating greater control over assets, may be a valuable strategy for increasing antenatal care attendance. Trial registration: ClinicalTrials.gov Identifier: NCT04111016, Date First Registered: 01/10/2019. [ABSTRACT FROM AUTHOR]

This study is quantitative in nature aims at investigating knowledge of women concerning antenatal care services and the factors that shape this knowledge. A questionnaire was prepared, judged and tested for validity and realiability then used to collect data from women attending Ahfad University Family Health Center. The questionnaire was analyzed using SPSS. The study reflected that woman indicated knowledge concerning the importance of antenatal-care and its relations to the health of the child and mother. It showed that the distance of the center from the place of residence (which is reflected by the literature as a inhibiting factor), is not so significant to hinder women from paying the regular visits to the center, while the economic factor, and the long-wait to meet the health care providers were cited as important in making or missing visits to the Family Health Care Center. Using appointment system to reduce the waiting time for the pregnant women to see health providers and increase the frequency of delivering health education as well as promoting programs were recommended to help those women who reflected that they do not attend antenatal health centers. [ABSTRACT FROM AUTHOR]

Introduction: in Ethiopia, increasing access to basic antenatal and neonatal health services may improve maternal and newborn survival. This study examined perceptions regarding antenatal health seeking behaviors from pregnant women, their families, community members, and health care providers in rural Amhara, Ethiopia. Methods: the study was conducted in four rural districts of the Amhara region of Ethiopia. A total of forty participants who were living and working within the catchment areas of the selected health centres were interviewed from October 3rd through October 14th, 2018. A phenomenological qualitative study design was used to understand participants' perceptions and experiences about pregnant women's health care seeking behaviors. Results: early disclosure of pregnancy status was not common in the study area. However, the data from the present study further provided new information, suggesting that some women did disclose their pregnancy status early but preferentially only to their partners and close relatives. Most women did not seek care unless sick or experienced new discomfort or pain. Some reasons for the low utilization of available antenatal services include long distance to health facilities, lack of transportation, difficult topography, and discomfort with male providers. Conclusion: despite the rapid expansion of health posts and deployment of health extension workers since 2003, there are still critical barriers to accessing facility-based care that limit women's health care seeking practices. [ABSTRACT FROM AUTHOR]

Background: The World Health Organization introduced a new model of care, 'The 2016 WHO ANC Model' to overcome challenges encountered during the implementation of the Focused Antenatal Care Approach. For any new intervention to achieve its objective, it must be widely accepted by both the deliverers and recipients. Malawi rolled out the model in 2019 without carrying out acceptability studies. The objective of this study was to explore the perceptions of pregnant women and health care workers on the acceptability of 2016 WHO's ANC model in Phalombe District, Malawi using the Theoretical Framework of Acceptability. Methodology: We conducted a descriptive qualitative study between May and August 2021. The Theoretical Framework of Acceptability was used to guide the development of study objectives, data collection tools, and data analysis. We purposely conducted 21 in-depth interviews (IDIs) among pregnant women, postnatal mothers, a safe motherhood coordinator, and Antenatal care (ANC) clinic midwives, and two focus group discussions (FGDs) among Disease Control and Surveillance Assistants. All IDIs and FGDs were conducted in Chichewa, digitally recorded, and simultaneously transcribed and translated into English. Data was analysed manually using content analysis. Results: The model is acceptable among most pregnant women and they reckoned that it would help reduce maternal and neonatal deaths. Support from a husband, peers, and health care workers facilitated acceptability of the model while the increased number of ANC contacts which resulted in fatigue and increased transportation cost incurred by the women was a deterrent. Conclusion: This study has shown that most pregnant women have accepted the model despite facing numerous challenges. Therefore, there is a need to strengthen the enabling factors and address the bottlenecks in the implementation of the model. Furthermore, the model should be widely publicised so that both intervention deliverers and recipients of care implement the model as intended. This will in turn help to achieve the model's aim of improving maternal and neonatal outcomes and creating a positive experience with health care among pregnant women and adolescent girls. [ABSTRACT FROM AUTHOR]

Background: Reducing maternal mortality ratio (MMR) has been a worldwide public health challenge for a long time. Utilization of maternal health services including antenatal care (ANC), institutional delivery (ID), and postnatal care (PNC) is vital to prevent maternal mortality. China has made significant improvements in maternal health during the past 30 years, however, disparities in maternal health service utilization still exist among regions and the western rural areas had the lowest utilization rate. This study aims to assess the inequality and determinants of maternal health service utilization in western poverty-stricken rural areas based on Anderson's Behavioral Model of Health Service Use and provide evidence-based suggestions to improve equity and coverage of maternal service utilization in China. Methods: A cross-sectional study was conducted in Gansu and Yunnan Province, Western China using primary data (n = 996) collected by the research team. A multistage, judgment, quota sampling procedure was employed to select the participants of the survey. Trained local health staff formed an interview team to help respondents answer a structured, pre-tested questionnaire designed based on Anderson's model. Data collected through interviews were used for descriptive analysis, range analysis, and univariate and multivariate binary logistic analysis to identify influencing factors of 5 + ANC, 8 + ANC, ID, and 2 + PNC utilization. Results: Place of residence, age, education level, annual income, and health education during ANC were influencing factors of 5 + ANC; place of residence, education level, per capita household income, conditional cash transfer (CCT) participation, and distance to health facilities were influencing factors of 8 + ANC; place of residence, education level, and availability of financial incentive programs were influencing factors of ID; number of children, health education during ANC, CCT projects participation, and self-rated health status were influencing factors of 2 + PNC. Conclusions: Inequalities in maternal service utilization exist between Yunnan and Gansu provinces. This study shows a strong association between both predisposing and enabling factors and maternal services utilization. Predisposing factors such as place of residence, education level, and number of children, enabling factors such as CCT participation, annual income, health education during ANC, and distance to health facilities along with need factor self-rated health status all contribute to maternal services utilization. We conclude that many factors influence maternal service utilization and interventions targeted at various levels should be considered. Therefore, we suggest more health resources should be invested in underutilized areas, financial incentive projects targeting pregnant women should be implemented, and health education should be provided to improve women's health literacy. [ABSTRACT FROM AUTHOR]

Background: India contributes 15% of the total global maternal mortality burden. An increasing proportion of these deaths are due to Pregnancy Induced Hypertension (PIH), Gestational Diabetes Mellitus (GDM), and anaemia. This study aims to evaluate the effectiveness of a tablet-based electronic decision-support system (EDSS) to enhance routine antenatal care (ANC) and improve the screening and management of PIH, GDM, and anaemia in pregnancy in primary healthcare facilities of Telangana, India. The EDSS will work at two levels of primary health facilities and is customized for three cadres of healthcare providers – Auxiliary Nurse Midwifes (ANMs), staff nurses, and physicians (Medical Officers). Methods: This will be a cluster randomized controlled trial involving 66 clusters with a total of 1320 women in both the intervention and control arms. Each cluster will include three health facilities—one Primary Health Centre (PHC) and two linked sub-centers (SC). In the facilities under the intervention arm, ANMs, staff nurses, and Medical Officers will use the EDSS while providing ANC for all pregnant women. Facilities in the control arm will continue to provide ANC services using the existing standard of care in Telangana. The primary outcome is ANC quality, measured as provision of a composite of four selected ANC components (measurement of blood pressure, blood glucose, hemoglobin levels, and conducting a urinary dipstick test) by the healthcare providers per visit, observed over two visits. Trained field research staff will collect outcome data via an observation checklist. Discussion: To our knowledge, this is the first trial in India to evaluate an EDSS, targeted to enhance the quality of ANC and improve the screening and management of PIH, GDM, and anaemia, for multiple levels of health facilities and several cadres of healthcare providers. If effective, insights from the trial on the feasibility and cost of implementing the EDSS can inform potential national scale-up. Lessons learned from this trial will also inform recommendations for designing and upscaling similar mHealth interventions in other low and middle-income countries. Trial Registration. ClinicalTrials.gov, NCT03700034, registered 9 Oct 2018, https://www.clinicaltrials.gov/ct2/show/NCT03700034 CTRI, CTRI/2019/01/016857, registered on 3 Mar 2019, http://www.ctri.nic.in/Clinicaltrials/pdf_generate.php?trialid=28627&EncHid=&modid=&compid=%27,%2728627det%27 [ABSTRACT FROM AUTHOR]

Crohn's disease affects many women of childbearing age. Fecundity rates are often lower than in the general population due to reduced fertility during active inflammation, effects of pelvic surgery or voluntary childlessness. Many women have concerns regarding the effects of pregnancy on their Crohn's, any potential effect of medication on the fetus, and passing on Crohn's disease to the offspring. International guidelines on reproduction for women with Crohn's disease provide evidence-based advice to patients and health care professionals. There is an increasing literature on the safety of advanced medication for Crohn's disease during pregnancy. This review article therefore focuses on obstetric considerations beyond medication safety. We provide information on fertility, factors affecting pregnancy and fetal outcomes, obstetric complications, factors influencing mode of delivery, management of intestinal stomas during pregnancy and general considerations around breast feeding. [ABSTRACT FROM AUTHOR]

Background: Pregnancy is the most crucial thing for every mother. Providing appropriate health-care services during pregnancy by skilled health care professionals is important for healthy childbirth and better maternal health outcomes. Despite Antenatal care services being free at the Public Hospital in Sikkim, many pregnant women are reluctant to get ANC services because of many socio-economic and demographic factors. Objectives: The present study aimed to identify various socio-economic and demographic determinants affecting ANC services utilization among rural women of South Sikkim, India. Methods: The community-based cross-sectional study was carried out among 250 reproductive-aged (15-49 years) women residing in South Sikkim, India. The data on various socio-economic and demographic determinants associated with utilization of antenatal care services were collected by adopting a pre-structured schedule interview method by household visits. Results: A total of 73.4% reported that they have utilized the ANC services among women in South Sikkim. Binary logistic regression analysis indicated that several socio-economic and demographic variables of age, age at marriage, age at pregnancy, marital status, family income, education, education of husband, occupation of husband parity and family income were significantly associated with ANC visits (p<0.05), except women's occupation and religion (p>0.05). Conclusion: There is an urgent need to inform pregnant women and their families about the importance of ANC services to enhance effective utilization and improve the overall health status. [ABSTRACT FROM AUTHOR]

Introduction: Group Antenatal Care (GANC) is an alternative for traditional antenatal care. Despite the model is well accepted among participants and is associated with positive effects on pregnancy outcomes, recruitment of participants can be an ongoing challenge, depending on the structure and financing of the wider health system. This is especially the case for primary care organizations offering GANC, which depend on other health care providers to refer potential participants. The main objective of this study is to understand what determinants are at play for health care providers to refer to GANC facilitators in primary care organizations. Accordingly, we make recommendations for strategies in order to increase the influx of women in GANC. Methods: Qualitative findings were obtained from 31 interviews with healthcare providers responsible for the referral of women to the GANC facilitators working in primary care organizations, GANC facilitators and stakeholders indirectly involved in the referral. The domains of the Consolidated Framework for Implementation Research (CFIR) and the Theoretical Domains Framework (TDF) helped to develop interview questions and raise awareness of important elements during interviews and thematic analyses. Results: The findings show that before health care providers decide to refer women, they undergo a complex process that is influenced by characteristics of the potential referrer, GANC facilitator, woman, professional relationship between the potential referrer and the GANC facilitator, organization and broader context. Discussion: Based on these findings and current literature, we recommend that the GANC team implements strategies that anticipate relevant determinants: identify and select potential referrers based on their likelihood to refer, select champions, invest in communication, concretise the collaboration, provide practical tools, involve in policymaking. [ABSTRACT FROM AUTHOR]

Background: Aboriginal women and their infants experience significant disadvantage in health outcomes compared to their non-Aboriginal counterparts. Access to timely, effective, and appropriate maternal and child health care can contribute to reducing these existing health disparities. This research sought to explore factors that contribute to continuity of care for Aboriginal women and their infants living in metropolitan South Australia. This paper reports on the perspectives of health care workers in mainstream health services from the antenatal period to the end of an infants' second birthday. It explores health workers' perspectives of what contributes to positive care experiences and satisfaction with care provided to Aboriginal women and their infants in mainstream health. Methods: Eight focus groups were held with 52 health professionals. Participants included Aboriginal Cultural Child and Family Support Consultants (n = 7), Aboriginal Maternal Infant Care Workers (n = 3), Midwives (n = 3) and Child and Family Nurses (n = 39). Data was inductively coded and thematically analysed. Results: Three key themes emerged: the system takes priority, culture is not central in approaches to care, and 'we've got to be allowed to do it in a different way'. Conclusions: This research highlights a lack of continuity of care for Aboriginal families accessing mainstream health services from the antenatal period through to an infants' first 1000 days of life. This research has implications for communities, and it calls for strategies to enhance continuity, and healthcare services to provide appropriate and culturally safe care. Findings will inform and guide future changes to improve continuity of care for Aboriginal families and infants in the first 1000 days. [ABSTRACT FROM AUTHOR]

Background: Antenatal care coverage has dramatically increased in many low-and middle-income settings, including in the state of Telangana, India. However, there is increasing evidence of shortfalls in the quality of care women receive during their pregnancies. This study aims to examine dimensions of antenatal care quality in Telangana, India using four primary and secondary data sources.Methods: Data from two secondary statewide data sources (National Family Health Survey (NFHS-5), 2019-21; Health Management Information System (HMIS), 2019-20) and two primary data sources (a facility survey in 19 primary health centres and sub-centres in selected districts of Telangana; and observations of 36 antenatal care consultations at these facilities) were descriptively analysed.Results: NFHS-5 data showed about 73% of women in Telangana received all six assessed antenatal care components during pregnancy. HMIS data showed high coverage of antenatal care visits but differences in levels of screening, with high coverage of haemoglobin tests for anaemia but low coverage of testing for gestational diabetes and syphilis. The facility survey found missing equipment for several key antenatal care services. Antenatal care observations found blood pressure measurement and physical examinations had high coverage and were generally performed correctly. There were substantial deficiencies in symptom checking and communication between the woman and provider. Women were asked if they had any questions in 22% of consultations. Only one woman was asked about her mental health. Counselling of women on at least one of the ten items relating to birth preparedness and on at least one of six danger signs occurred in 58% and 36% of consultations, respectively.Conclusion: Despite high coverage of antenatal care services and some essential maternal and foetal assessments, substantial quality gaps remained, particularly in communication between healthcare providers and pregnant women and in availability of key services. Progress towards achieving high quality in both content and experience of antenatal care requires addressing service gaps and developing better measures to capture and improve women's experiences of care. [ABSTRACT FROM AUTHOR]

Background and Objective: Pregnant women are the most susceptible group for Iodine deficiency disorder (IDD) whose neonate are at the risk of brain impairment, if they are iodine deficient in utero. The study was carried out to analyze the concerns and effects regarding iodized salt and IDD in women seeking antenatal care in Pakistan Methods: A descriptive cross-sectional study was conducted in Obstetrics OPD at Civil Hospital Karachi from April 2017 to January 2018. In this study, antenatal care seeking women (n=360) visiting obstetric outpatient department (OPD) at public sector tertiary care hospital of Karachi were interviewed face to face using a structured questionnaire. Systematic random sampling method was employed. Kruskal Wallis test was applied to assess the significance among study variables. Results: Sixty-three (63.6%) of pregnant women heard about iodized salt. Approximately 40.6% of them received iodized salt related information through mass media. Ninety (90.6%) were ignorant that their unborn child needs iodine for brain development. A statistically significant association was found between the educational status (p<0.001), household income (p<0.001), age (p=0.016), ethnicity (p=0.018), trimester (p=0.005) with the knowledge of study participants regarding iodized salt and IDD. Conclusion: There is an immense need to address the present concerns of women seeking antenatal care by advocacy and health education on individual and at mass level regarding the use of iodized salt among women seeking antenatal care. Advocacy can be done by governmental initiatives, medical personnel and through mass media in all tertiary care hospitals of Pakistan. [ABSTRACT FROM AUTHOR]

Background: Up to 95% of pregnant women with alcohol and other drug (AOD) problems also smoke tobacco. Challenging psychosocial circumstances and a lack of targeted tobacco interventions contribute to low rates of prenatal abstinence and more effective treatment strategies are required. This study explores smoking in pregnant clients of AOD treatment services from a consumer and healthcare provider perspective to examine characteristics of behaviour change and the acceptability of evidence-based tobacco treatment strategies. Outcomes will support the design and implementation of a comprehensive tobacco intervention. Methods: A mixed methods triangulated design was used. Thirteen women who smoked and attended antenatal AOD services in New South Wales, Australia, were interviewed and 28 clinicians from the same services were surveyed. Domains including experiences of tobacco smoking in pregnancy, motivators and barriers to cessation and evidence-based strategies to assist cessation during pregnancy were explored. Interviews were analysed using Iterative Categorization, with interpretation guided by Qualitative Description. Online surveys were analysed descriptively. A convergent-parallel mixed methods analysis was performed. Results: Women and clinicians agreed that improving baby's health outcomes was the primary motivation to stop smoking. Negative experiences with nicotine replacement therapy (NRT), financial constraints and maternal contraindications restricted its uptake and effectiveness during pregnancy. Both groups agreed that other AOD use, stopping multiple substances concurrently, difficulty coping with stress and the influence of partners who smoke had the biggest impacts on cessation efforts. Clinicians favoured harm-reduction rather than abstinence-based tobacco interventions and women appeared satisfied with reduction efforts. Both views may influence the attainment of prenatal abstinence-based goals. Although previous evidence suggested the contrary, clinicians were willing to encourage simultaneous cessation of tobacco and other substances. Non-judgmental treatment approaches that provide extra support, education and motivation were important for women. Women and clinicians supported use of NRT despite concerns. Financial incentives, counselling, partner support and offering tobacco treatment with antenatal AOD care were considered acceptable treatment options. Conclusions: NRT, incentives, counselling and partner support could be utilized in a tobacco intervention for pregnant women with substance use concerns. Non-judgmental education, motivation, and provision of NRT including instruction for correct use are important considerations. [ABSTRACT FROM AUTHOR]

Background: Antenatal care (ANC) is a service that can reduce the incidence of maternal and neonatal deaths when provided by skilled healthcare workers. Patient satisfaction is an important health system responsiveness goal which has been shown to influence adherence to healthcare interventions. This study aims to assess the determinants of pregnant women's satisfaction with ANC across Kenya, Tanzania, and Malawi using nationally representative Service Provision Assessment data.Methods: Patient satisfaction was conceptualised mainly based on Donabedian's theory of healthcare quality with patient characteristics, structure, and process as the major determinants. Bivariate and multivariate analyses were conducted to identify the potential determinants.Results: Findings show that satisfaction was negatively associated with women's age (AOR: 0.95; 95% CI: 0.92-0.99) and having a secondary (AOR: 0.39; 95% CI: 0.17-0.87) or tertiary education (AOR: 0.41; 95% CI: 0.17-0.99) in Kenya. Women on their first pregnancy were more likely to report satisfaction in Tanzania (AOR: 1.62; 95% CI: 1.00-2.62) while women were less likely to report being satisfied in their second trimester in Malawi (AOR: 0.31; 95% CI: 0.09-0.97). The important structural and process factors for patient satisfaction included: private versus public run facilities in Kenya (AOR: 2.05; 95% CI: 1.22-3.43) and Malawi (AOR: 1.85; 95% CI: 0.99-3.43); level of provider training, that is, specialist versus enrolled nurse in Tanzania (AOR: 0.35; 95% CI: 0.13-0.93) or clinical technician in Malawi (AOR: 0.08; 95% CI: 0.01-0.36); and shorter waiting times across all countries.Conclusion: Findings highlight the importance of professional proficiency and efficient service delivery in determining pregnant women's satisfaction with ANC. Future studies should incorporate both patient characteristics and institutional factors at health facilities into their conceptualisation of patient satisfaction. [ABSTRACT FROM AUTHOR]

Background: Pregnant women who had full antenatal care follow-up are expected to give birth in health facilities. However, in Ethiopia, after full antenatal care booking, many women still prefer to give birth at home. Thus, the purpose of this study was to explore and describe why women give childbirth at home after full antenatal care follow-up in the study setting. Methods: Exploratory-descriptive qualitative design was conducted in Humbo and Abala Abaya districts, Southern Ethiopia, from June to September 2020. Nine in-depth interviews and four focus group discussions were held with purposively selected participants. Women who gave birth at home after attending equal to or more than four antenatal care appointments in the last year were included. The collected data were majorly analyzed by inductive thematic analysis technique, but deductive analysis was also applied whenever the potential themes needed further enrichment. A thick description of the findings is done in the respective heading and sub-heading using participants' verbatim quotations. Results: A total of 9 in-depth interviews and four focus group discussions comprising 35 participants was conducted. Three major themes and nine sub-themes emerged from the data. Socio-cultural and community influences, socio-economic obstacles, and health system-related barriers are the major themes identified. Traditional practices, personal beliefs, social norms, knowledge, and attitude about institutional delivery, household economic capability, decision-making capacity of the women, delivery service quality, and service providers related barriers are the sub-themes defining the home delivery experience of women after full antenatal care follow-up in the study setting. Conclusion: In this study, socio-economic, cultural, and health system-related barriers are major reasons for home delivery. Improvement of public awareness on the risk of home delivery and elimination of its facilitative social norms, empowerment of women's economic, educational, and decision-making capability and healthcare workers' and health facilities' capacity are recommended. [ABSTRACT FROM AUTHOR]

Background: According to WHO, 536,000 women die every year in the world from causes relating to pregnancy, childbirth, or postpartum. Ninety nine percent of these deaths occur in the developing countries. Primary health centres (in densely populated areas and in urban slums are also referred to as family welfare centres, since they provide the whole continuum of care, from birth through adolescent and delivery and thereafter. Aim: To evaluate the antenatal services under Reproductive, Maternal, Newborn, Child plus Adolescent (RMNCHA) programme at a family welfare centre located in Central Delhi, India. We have proposed an action plan that will help in evaluating and improving these services. Methodology: The study included health providers of antenatal services and the beneficiaries. With a response rate of 90% from a sample of 218, 203 consenting antenatal women (beneficiaries) visiting the centre for ANC check-up under RMNCH + A programme and PMSMA were included. For quantitative component, a pre-designed, pre-tested semi-structured screening questionnaire were administered to the beneficiaries and healthcare providers to evaluate the antenatal services under RMNCH + A programme at the family welfare centre. Results: Qualitative and quantitative analysis was done separately. Only 43% of ANC women said health workers visited them at home during pregnancy and very few could tell about importance of lab investigations. Almost all (97%) knew about key messages given by health workers. Nearly all participants considered that the screening process was smooth. The waiting time and time to undergo varied from 4 to 6 min. [ABSTRACT FROM AUTHOR]

Background: High-risk pregnancy (HRP) puts current pregnancy at an increased risk of complications. In the absence of pre-existing HRP implementation model of the country, in collaboration with the Government of Himachal Pradesh, a new digital HRP model called the 'SEWA—A System E-approach for Women at risk' was developed. The current article demonstrates a model for the early identification and line listing of high-risk pregnant women (PW) with appropriate referrals and increased engagement with the healthcare workers using a digital tool in the form of the Android App. Methods: SEWA was implemented as a pilot intervention in two community development blocks of the Chamba district. The key implementation steps included finalizing protocols for the identification of HRPs, defining processes and roles, mapping health facilities, setting up the communication loop, and developing of digital solutions. The digital app, used by the auxiliary nurse midwife (ANM) and program officers, tracked PW for a year from October 19 to October 20 and recorded the ANC visits, referrals, and birth outcomes. A qualitative assessment was conducted among the health workers to find out their level of acceptance. Results: A total of 1,340 high-risk PW were identified. The intervention year saw a rise in the identification of HRP to 27.9% from 3.5% in the previous year. A total of 2,559 conditions were tagged to the identified 1,340 women categorized into current pregnancy (81%), previous pregnancy (16%), and any existing chronic illness (3%). A majority of the women who required urgent referrals were provided referrals. The application recorded 53% of the delivered HRP with a digital birth preparedness plan, prepared and shared with the PW and Accredited Social Health Activists (ASHA), by text message for compliance. Conclusion: The SEWA application is a feasible and sustainable solution to complement the competency of the care providers for early identification of the high-risk conditions and reduce the burden of preventable unprecedented deaths around the time of birth. [ABSTRACT FROM AUTHOR]

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Background: Nutritional awareness and practice of women during pregnancy could be determining their nutritional status, which significantly affects the outcome of pregnancy. Therefore this study aims to explore the maternal nutrition counseling provided by health professionals for pregnant women, Barriers to maternal nutrition, and major interventions. Methods: A descriptive study design with a qualitative method by using ground theory tradition, based on constructivist research approach and Charmaz's (2000) study design has been conducted from September-01/2019 _November-16/2019 among pregnant women who got ANC service in Addis Ababa, Ethiopia. A purposive sampling technique was used. Practical observations and in-depth interviews were conducted. The sample size adjustment has been carried out according to the information saturation obtained, and finally, 81 practical observations, In-depth interview with two center managers, nine health professionals and eleven term pregnant women has been conducted. An observational checklist and Semi-structured, open-ended questionnaires were used. Data, the environment, and methodological triangulation were carried out. A conceptual framework has been established based on the data collected about the whole process of maternal nutrition counseling during pregnancy. ATLAS TI software was utilized for information analysis. The results: Most participants responded that maternal nutrition counseling provided to pregnant mothers is not adequate and neglected by most stakeholders. From 81 practical observations, health professionals counseled to mothers were 10 what to feed, 4 what to limit to consume, and 5 were counseled about what to eat during pregnancy. Close to all the respondents agreed on the importance of providing nutrition counseled by the nutritionists. Most of the study participants emphasized a shortage of time as primary barriers. Institutional Barriers, Professional Barriers, Maternal Barriers, and Community Barriers were major barriers to nutrition counseling. Conclusions: Generally, maternal nutrition counseling provided to pregnant mothers was not adequate and neglected by most stakeholders. Shortage of time due to client flow, Institutional Barriers, Professional Barriers, Maternal Barriers, and Community Barriers were major categories of maternal nutritional counseling barriers. Information update and timely preparation were recommended to health professionals. [ABSTRACT FROM AUTHOR]

Anemia in pregnancy is a risk factor for maternal and neonatal mortality and morbidity. Iron deficiency anemia (IDA), the most common type of anemia in pregnancy, adversely affects the well-being of both the mother and the child. Iron--folic acid supplementation (IFAS), a cost-effective public health intervention of IDA in pregnancy recommended by the World Health Organization (WHO), is implemented globally with the Philippines included. However, only 19% of Filipino pregnant women take the recommended number of 180 IFAS tablets. This is considered a factor in the prevalence of anemia in pregnancy. Very low IFAS uptake was due to the behaviors and practices of both pregnant women and healthcare providers. Limited awareness on the impact of anemia in pregnancy and the significance of IFAS, late and less frequent antenatal care (ANC) visits, experience of side effects and unpleasant taste of the supplement, and not receiving or purchasing supplements were the identified factors to low IFAS compliance. Among healthcare providers, a low level of IFAS compliance was found to be related to the late reporting of pregnant women to the antenatal facility, and inability to motivate and provide appropriate counseling regarding the supplementation's use and significance. Behaviors and practices of pregnant mothers toward IFAS compliance appear to be a result of healthcare providers' inadequate healthcare services. Therefore, healthcare providers need to improve their ANC program and revisit their approaches on existing health and nutrition promotion programs, health education and counseling techniques, follow-up and monitoring strategies, and ANC visits promotion efforts. These efforts were found effective in well-informed and empowered pregnant women to IFAS compliance and other significant ANC access. Improved IFAS compliance will eventually contribute to lower the prevalence of anemia in pregnancy for better maternal and neonatal outcomes. [ABSTRACT FROM AUTHOR]

Background: Male partner involvement in antenatal care is a crucial component in the optimization of maternal health. Uptake is low in developing countries since few men engage in care. Non-involvement is a global concern identified by researchers and needs addressing. Objective: To identify institutional determinants of male partner involvement in antenatal care (ANC) at Anti- Stock-Theft-Unit in Gilgil ward of Nakuru County. Design was Cross-sectional descriptive research design. Subjects were 334 sampled from a population of 2582 through simple random sampling. Data was gathered using self-administered questionnaires, and then edited, coded, and organized with help of statistical Package of Social Sciences (SPSS) Microsoft excel computer.It was then analysed using descriptive and inferential statistics. Chi square and Fishers exact tests were performed to test the hypothesis. The information was presented using tables and percentages. Results showed (91.0%) of the respondents indicated facilities are dominated by female workers.Of ( 88.9%) of the participants who accompanied the partners during first ANC visit indicated that they were comfortable with female health personnel while,( 90.9%) who did not accompany the partners indicated that they were not comfortable with female health workers (p=.0.036). Slightly less than half (44.6 %) of the subjects opined that health workers had wanting reactions.90% of the participants who accompanied the partners during the first ANC visit indicated that health workers were good friendly and kind. However 85.7% of those who did not accompany the partners attributed it to health workers wanting responses p=(2-sided) 0.017). Conclusions: Gender and health care workers were significant to male partner involvement in antenatal care. [ABSTRACT FROM AUTHOR]

Background: This trial evaluates interventions that utilize data entered at point-of-care in the Palestinian maternal and child eRegistry to generate Quality Improvement Dashboards (QID) for healthcare providers and Targeted Client Communication (TCC) via short message service (SMS) to clients. The aim is to assess the effectiveness of the automated communication strategies from the eRegistry on improving attendance and quality of care for pregnant women.Methods: This four-arm cluster randomized controlled trial will be conducted in the West Bank and the Gaza Strip, Palestine, and includes 138 clusters (primary healthcare clinics) enrolling from 45 to 3000 pregnancies per year. The intervention tools are the QID and the TCC via SMS, automated from the eRegistry built on the District Health Information Software 2 (DHIS2) Tracker. The primary outcomes are appropriate screening and management of anemia, hypertension, and diabetes during pregnancy and timely attendance to antenatal care. Primary analysis, at the individual level taking the design effect of the clustering into account, will be done as intention-to-treat.Discussion: This trial, embedded in the implementation of the eRegistry in Palestine, will inform the use of digital health interventions as a health systems strengthening approach.Trial Registration: ISRCTN Registry, ISRCTN10520687 . Registered on 18 October 2018. [ABSTRACT FROM AUTHOR]

The World Health Organization (WHO) recommends the need for a strong nutrition training package for practitioners, including antenatal care (ANC) providers. Without such a training package, ANC visits remain a missed opportunity to address nutritional problems among pregnant women. This study evaluated the effectiveness of an in-service nutrition education and counselling package on the providers' counselling skills during ANC visits. A cluster randomized controlled trial was conducted in Addis Ababa, Ethiopia. All health-care providers working in ANC units across 20 health centres participated in this study. Health centres were allocated to intervention and control arms using a matched-pair randomization technique. An in-service nutrition education and counselling package, including training for ANC providers, supportive supervision and provision of modules, pamphlets and job aids, was provided for health centres assigned to the intervention arm. Observation checklists were used to assess the counselling skills of health-care providers. We used mixed-effect linear regression to evaluate the impact of the intervention. Significantly more health-care providers in the intervention arm informed pregnant women about the need to have one additional meal (Difference in proportion [DP] 49.17% vs -0.84%; DID 50.0%), about minimum required dietary diversity (DP 72.5% vs -2.5%; DID 75.0%) and about gestational weight gain (DP 68.33% vs -8.33%; DID 76.6%). Furthermore, providers improved in identifying key difficulties that pregnant women face (DP 28.34% vs -2.5%; DID 30.8%), and in recommending simple achievable actions on nutrition during pregnancy (DP 20.8% vs -10.9%; DID 31.6%). The intervention did not have statistically significant effects on how providers informed women about early initiation of breastfeeding (DP 6.67% vs 9.17%; DID -2.5%). The comprehensive in-service nutrition education and counselling package improved how ANC providers engaged with pregnant women and delivered nutrition messages during ANC consultations. This trial was registered in the Pan African Clinical Trial (PACTR registry, PACTR20170900 2477373; Date issued 21 September 2017). [ABSTRACT FROM AUTHOR]

Background: Antenatal care (ANC) is one of the most cost-effective and crucial components of maternal health care services. In developing countries where access to care, empowerment, and decision making power of women is low, ANC service is vital. The time at which first ANC visit was done has the utmost importance to ensure optimal health effects for both women and children. This study aimed to assess the proportion and factors associated with early antenatal care booking among pregnant women who were attending public health institutions in a remote area of Bule Hora district, Southern Ethiopia, from May to July, 2019. Methods: Institutional-based cross-sectional study design was conducted at Bule Hora district public health facilities. Data were collected on systematically selected 377 pregnant women from 1st May to 30th July 2019. The sample size was determined by single population proportion formula and data were collected by using a standardized and pretested questionnaire and entered into Epidata 3.1 version, and then exported to Statistical Package for Social Science (SPSS) version 25 for analysis. The strength of association was measured by odds ratios with 95% confidence interval (CI) at a p-value of < 0.05 and finally obtained results were presented by using simple frequency tables, bar graph, and texts. Results: The proportion of early antenatal care booking among pregnant women attending antenatal care in the study area was 57.8%. Factors contributing to early antenatal care booking were husband's education (Adjusted odds ratio (AOR), 2.5; 95% CI: 1.2, 4.9), knowledge on antenatal care service (AOR,1.99; 95% CI:1.2,3.3), means of approving current pregnancy (AOR,1.8; 95% CI:1.1,2.8), and being advised before starting antenatal care visit (AOR,2.1; 95% CI:1.2,3.6). Conclusion: Generally, the timely initiation of ANC among pregnant mothers is not ideal. Modifiable factors like husband's education, knowledge on antenatal care service, means of recognizing current pregnancy, and access to pre-ANC advice were found determinants for the timely initiation of ANC. Thus, it is advisable to provide proper information about antenatal care services by health care providers and enhancement of health extension program to increase community awareness before and during pregnancy at all levels of health care provision is very important. [ABSTRACT FROM AUTHOR]

Objective: To investigate the temporal trend of socioeconomic and rural-urban disparities and geographical variation in the utilization of antenatal care (ANC) services in India before and throughout the Millennium Development Goals era.Data Sources/study Setting: For this temporal analysis, secondary data from the Indian National Family Health Surveys between 1998 and 2015 (Waves 2, 3, and 4) were used.Study Design: We analyzed the trend in inequality for at least one and four ANC visits to a health care professional (ANC1+ and ANC4+, respectively) by education, wealth, and residence type. Multilevel logistic regression models were used to assess the temporal trend and the relative contribution of communities and states to the overall variation in ANC1+ and ANC4+.Data Collection/extraction Methods: Data on utilization of ANC services for the last birth of women aged 15-49 years during the three or five years preceding the survey (depending on the survey year) were used.Principal Findings: Educational and wealth inequality in ANC1+ and ANC4+ worsened between 1998 and 2005 and improved between 2005 and 2015 (for ANC4+, OR [95% CI] = 0.22 [0.19-0.25] in Wave 2; OR [95% CI] = 0.19 [0.17-0.22] in Wave 3; and OR [95% CI] = 0.38 [0.36-0.40] in Wave 4 for the poorest). Rural-urban inequality showed a consistent decline (for ANC4+, OR [95% CI] = 0.59 [0.54-0.64] in Wave 2; OR [95% CI] = 0.63 [0.59-0.68] in Wave 3; and OR [95% CI] = 0.82 [0.79-0.85] in Wave 4 for rural area). The relative contribution of the community to the total geographic variation in the utilization of ANC services increased more than four times during the study period.Conclusions: The use of ANC services remains disproportionately lower among women with low socioeconomic status. Efforts to directly target these women are necessary to tackle inequality in ANC utilization in India. [ABSTRACT FROM AUTHOR]

Background: The World Health Organisation recommends women have at least four antenatal care visits (ANC) during a low risk pregnancy. However, in Saudi Arabia, many mothers miss these appointments, placing their health and that of their baby at risk. Limited research which has explored why this is happening has focused on low maternal education or personal barriers such as lack of transport. The aim of the current research was therefore to understand what factors at the individual and healthcare systems level were associated with missing antenatal care in Saudi Arabia.Methods: Two hundred and forty-two pregnant women in their third trimester completed a questionnaire examining their care attendance (appointments missed, planned future attendance, timing of first appointment) alongside barriers to attending care. These included maternal demographic background, health literacy, personal barriers, health care system factors and staff communication).Results: Over half of women surveyed had missed at least one appointment and a third had delayed their care. Mothers who had missed or delayed appointments blamed health care system factors such as poor clinic facilities and waiting times. Attending care was not associated with maternal education or literacy, although mothers with a lower level of literacy were more likely to delay care. However, perceptions of staff communication, consistency and care were lower amongst mothers who had missed at least one appointment.Conclusions: Although in previous research health professionals believe it is maternal education that leads to poor attendance, in our sample at least, perceptions of staff communication and clinic facilities were instead associated with attendance. Making changes at the health care level e.g. through adapting clinic times and investing in staff training may increase antenatal care attendance in Saudi Arabia. [ABSTRACT FROM AUTHOR]

Background: The use of intermittent preventive treatment-sulphadoxine–pyrimethamine (IPT-SP), adapted by Nigeria, is one key preventive strategy recommended by the World Health Organization. Because antenatal clinics serve as the usual entry point for IPT-SP implementation, this study explored healthcare workers' knowledge and practice, which are key to optimal IPT-SP coverage. Aim: This study aimed to explore the knowledge and practices of healthcare workers on the direct observation of IPT-SP amongst pregnant women attending antenatal care (ANC) in the Bwari Area Council (BWAC) of the Federal Capital Territory, Abuja, Nigeria. Setting: The study took place at five different wards of Bwari Area Council and eight Antenatal care facilities in Abuja, Federal Capital Territory, Nigeria. Methods: In-depth interviews and indirect observations were conducted among purposively selected healthcare workers in charge of the ANC of the eligible facilities. The study explored the knowledge and practices of healthcare workers on intermittent preventive treatment. Data were transcribed, translated and manually coded, and thematic analysis was conducted. Results: Healthcare workers' knowledge of IPT-SP, mode of administration and the rationale behind the use were poor. They all agreed that IPT-SP is supposed to be administered as a directly observed therapy at the clinic, but this practice was non-existent. Conclusion: The findings indicate that factors such as adequate technical skill, accessibility and availability of logistics influence knowledge and practice of IPT service delivery. Therefore, measures should be put in place to address gaps identified by this study. [ABSTRACT FROM AUTHOR]

Background: Antenatal care (ANC) provides healthcare services to pregnant women in an attempt to ensure, the best possible pregnancy outcome for women and their babies. Healthcare providers' understanding of their patient's behaviour and reasons for engagement in care and their response to this insight can influence patient-provider interactions and patient demand for ANC early in pregnancy. We examined the insight of healthcare providers into women's reasons for starting ANC later than the South African National Department of Health's recommended 20 weeks gestation. We also looked at the impact of late ANC presentation on overall healthcare providers' work experiences and their response in their interactions with patients.Methods: In-depth interviews were conducted with 10 healthcare providers at Maternal Obstetrics Units (MOU) and Primary Healthcare Centres (PHC) in Gauteng, South Africa. Healthcare providers were selected with the assistance of the facility managers. Data analysis was conducted using the qualitative analysis software NVivo 11, using a thematic approach of pinpointing, examining, and recording patterns within the data.Results: Healthcare providers were aware of patients need for secrecy in the early stages of pregnancy because of fears of miscarriage and women's preference for traditional care. Women with prior pregnancies presumed to know about stages of pregnancy and neglected to initiate ANC early. Barriers to early ANC initiation also include, women's need to balance income generating activities; travel cost to the clinic and refusal of care for coming after the daily patient limit has been reached. Healthcare providers encounter negative attitudes from un-booked patients. This has a reciprocal effect whereby this experience impacts on whether healthcare providers will react with empathy or frustration.Conclusions: Timing of ANC is influenced by the complex decisions women make during pregnancy, starting from accepting the pregnancy itself to acknowledging the need for ANC. To positively influence this decision making for the benefit of early ANC, barriers such as lack of knowledge should be addressed prior to pregnancy through awareness programmes. The relationship between healthcare providers and women should be emphasized when training healthcare providers and considered as an important factor that can affect the timing of ANC. [ABSTRACT FROM AUTHOR]

Malawi’s Option B+ program is based on a ‘test and treat’ strategy that places all HIV-positive pregnant and lactating women on lifelong antiretroviral therapy. The steep increase in patient load placed severe pressure on a health system that has struggled for decades with inadequate supply of health care workers (HCWs) and poor infrastructure. We set out to explore health system barriers to Option B+ by asking HCWs in Malawi about their experiences treating pregnant and lactating women. We observed and conducted semi-structured interviews (SSIs) with 34 HCWs including nine expert clients (ECs) at 14 health facilities across Malawi, then coded and analyzed the data. We found that HCWs implementing Option B+ are so overburdened in Malawi that it reduces their ability to provide quality care to patients, who receive less counseling than they should, wait longer than is reasonable, and have very little privacy. Interventions that increase the number of HCWs and upgrade infrastructure to protect the privacy of HIV-infected pregnant and lactating women and their husbands could increase retention, but facilities will need to be improved to support men who accompany their partners on clinic visits. [ABSTRACT FROM AUTHOR]

Background: The East Africa Preterm Birth Initiative-Rwanda began a cluster randomized controlled trial of group antenatal care (ANC) and postnatal care (PNC) in Rwanda in 2017. That trial will report its primary outcome, gestational length at birth, after data collection concludes in 2019. This nested study includes providers of ANC and/or PNC at the 18 health centers randomized to provide the group model of ANC/PNC and the 18 health centers randomized to continue providing ANC/PNC in the traditional, individual visit model. The objective of this study is to understand the experiences of providers of group ANC/PNC and compare their job satisfaction and perceived stress with individual ANC/PNC providers. Methods: We collected both quantitative and qualitative data from providers (nurses and midwives) who were recruited by health center directors to participate as group ANC and PNC facilitators at intervention sites and from a similar number of providers of standard ANC and PNC at control sites. Quantitative data was collected with questionnaires administered at baseline and approximately 9 months later (follow up). Qualitative data was collected in 3 focus groups of group ANC/PNC providers conducted one year after group care began. Results: Eighty-six percent of nurses and midwives surveyed who implemented group ANC and PNC reported that they prefer group care to the traditional individual model of ANC and PNC. Perceived stress levels and job satisfaction results were similar between groups. Mixed focus group discussions among both nurses and midwives experienced in group ANC and PNC suggest that the group model of care has advantages for both service beneficiaries and providers. When providers described implementation challenges, their peers in the focus groups offered them suggestions to cope and improve service delivery. Discussion: These results are consistent with studies of providers of group ANC and PNC in other LMIC contexts with respect to the perceived benefits of group care. This study adds new insights into the ways peer providers can help one another solve implementation problems. When given the opportunity to meet as a group, these study participants offered one another peer support and shared knowledge about best practices for successful implementation of group ANC/PNC. This trial is registered at clinicaltrials.gov as . [ABSTRACT FROM AUTHOR]

Background: Advancing maternal health is central to global health policy-making; therefore, considerable efforts have been made to improve maternal health. Still, in many developing countries, particularly in Sub-Saharan Africa and South Asia, including Afghanistan, the maternal mortality ratio (MMR) remains high. The objective of this study was to examine the determinants and current status of the utilization of maternal healthcare in Afghanistan. Methods: This study used the most recent data from the Afghanistan Demographic and Health Survey 2015. The unit of analysis for this study was women who had a live birth in the five years preceding the survey. The outcome variables were four or more antenatal care (ANC) visits, delivery assistance by a skilled birth attendant (SBA), and delivery by cesarean section (CS). The explanatory variables were basic sociodemographic characteristics of the mothers. We examined the sociodemographic characteristics of women utilizing ANC, SBA, and CS using descriptive statistics and estimated usage of ANC, SBA and CS after adjusting for maternal age and parity groups via direct standardization. Multivariable logistic regression models were employed to investigate the determinants of maternal healthcare variables. Results: Overall, 17.8% of women attended four or more ANC visits, 53.6% utilized an SBA, and 3.4% of women gave birth through CS. Women’s education, wealth status, urbanity, autonomy, and availability of their own transport were found to be the major determinants of service utilization. Conclusions: This study underscores low utilization of maternal healthcare services with wide disparities in Afghanistan and highlighted the need for an adequate health strategy and policy implementation to improve maternal healthcare uptake. [ABSTRACT FROM AUTHOR]

Objectives: Nigeria account for a significant proportion of adverse perinatal outcome. Nigerian studies assessing impact of time of delivery on perinatal outcome are scarce. This study evaluates any associations between time of delivery and perinatal outcome. Methods: This was a cross-sectional study at the Federal Teaching Hospital, Abakaliki from 01 January 2016 to 30 June 2018. Data were analysed with IBM SPSS version 25.0. Results: A total of 4,556 deliveries were analysed. Majority (72.2%) delivered on week days and 27.8% on weekends. Over 90% had 1st and 5th minutes Apgar scores ≥7. There was statistical difference in NICU admission between morning and evening hours (p = 0.009) but not between morning and night hours (p = 0.795). ENND during evening was twice higher (1.2%) than morning (0.5%); p = 0.047 and night hours (0.6%); p = 0.623.There was no difference in the risk of fresh stillbirths between morning and evening (p = 0.560), as well as morning and night hours (p = 0.75), there was also no difference in fresh stillbirths between week days and weekends (p = 0.895). There was no difference in low Apgar scores at 1st minute between morning and evening (p = 0.053) and night (p = 0.221), and between weekdays and weekends (p = 0.524). Similarly, there was no difference in low 5th minute Apgar scores between morning and evening (p = 0.165) and night (p = 0.944), as well as between week days and weekends (p = 0.529). However, ENND was twice (p = 0.085) and 1.3 times higher (p = 0.526) for evening and night hours respectively, while there was no difference between weekends and week days (p = 0.652). Conclusion: NICU admission and ENND were commoner during evening hours. However, work hours did not affect the rate of stillbirth and low Apgar scores during weekdays and weekends. It is pertinent for each obstetric unit to identify and modify factors responsible for unfavourable outcomes during various shifts, with the aim of improving perinatal health. [ABSTRACT FROM AUTHOR]