Search

BackgroundAntenatal care (ANC) is an essential platform to improve maternal and newborn health (MNH). While several articles have described the content of ANC in low- and middle-income countries (LMICs), few have investigated the quality of detection and management of pregnancy risk factors during ANC. It remains unclear whether women with pregnancy risk factors receive targeted management and additional ANC.Methods and findingsThis observational study uses baseline data from the MNH eCohort study conducted in 8 sites in Ethiopia, India, Kenya, and South Africa from April 2023 to January 2024. A total of 4,068 pregnant women seeking ANC for the first time in their pregnancy were surveyed. We built country-specific ANC completeness indices that measured provision of 16 to 22 recommended clinical actions in 5 domains: physical examinations, diagnostic tests, history taking and screening, counselling, and treatment and prevention. We investigated whether women with pregnancy risks tended to receive higher quality care and we assessed the quality of detection and management of 7 concurrent illnesses and pregnancy risk factors (anemia, undernutrition, obesity, chronic illnesses, depression, prior obstetric complications, and danger signs). ANC completeness ranged from 43% in Ethiopia, 66% in Kenya, 73% in India, and 76% in South Africa, with large gaps in history taking, screening, and counselling. Most women in Ethiopia, Kenya, and South Africa initiated ANC in second or third trimesters. We used country-specific multivariable mixed-effects linear regression models to investigate factors associated with ANC completeness. Models included individual demographics, health status, presence of risk factors, health facility characteristics, and fixed effects for the study site. We found that some facility characteristics (staffing, patient volume, structural readiness) were associated with variation in ANC completeness. In contrast, pregnancy risk factors were only associated with a 1.7 percentage points increase in ANC completeness (95% confidence interval 0.3, 3.0, p-value 0.014) in Kenya only. Poor self-reported health was associated with higher ANC completeness in India and South Africa and with lower ANC completeness in Ethiopia. Some concurrent illnesses and risk factors were overlooked during the ANC visit. Between 0% and 6% of undernourished women were prescribed food supplementation and only 1% to 3% of women with depression were referred to a mental health provider or prescribed antidepressants. Only 36% to 73% of women who had previously experienced an obstetric complication (a miscarriage, preterm birth, stillbirth, or newborn death) discussed their obstetric history with the provider during the first ANC visit. Although we aimed to validate self-reported information on health status and content of care with data from health cards, our findings may be affected by recall or other information biases.ConclusionsIn this study, we observed gaps in adherence to ANC standards, particularly for women in need of specialized management. Strategies to maximize the potential health benefits of ANC should target women at risk of poor pregnancy outcomes and improve early initiation of ANC in the first trimester.

Background: Clinical accompaniment is an activity predominantly supervised by the clinical facilitator to develop the skills of the students. In South Africa, clinical accompaniment aims to develop the skills of the students to equip them in delivering efficient health services to the patients. Previous studies revealed that students experienced challenges and were negatively affected due to inadequate clinical accompaniment in the learning practice. Aim: The aim was to determine the challenges faced by University of KwaZulu-Natal (UKZN) undergraduate nursing students during their clinical accompaniment. Methods: An observational cross-sectional study design, with an analytic component was implemented. Questionnaires were used to collect data. Of the 400 registered nursing students, 245 were undergraduates; of these, 241 consented to participate in this study. Data captured into SPSS Statistics Package V28. ANOVA were used in comparing challenges amongst participants. A p-value less than 0.05 was considered significant. Results: A total of 241 participants responded to the questionnaires, which yielded a response rate of 98.4%. This study comprised first-year (32.4%), second-year (32.8%) and third-year (34.9%) students. There was no remarkable difference in terms of challenges amongst study participants (1st; 2nd; 3rd), p=0.592. Conclusion: This study revealed the challenges faced by undergraduate nursing students during their clinical accompaniment. Contribution: Study results might assist in developing effective guidelines to resolve the challenges encountered by students.