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

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

Background: Antenatal health information enables pregnant women to make informed choices for their health during pregnancy and childbirth. Worldwide, evidence shows inadequate coverage of the information provided to women during antenatal care visits. Interaction between women and providers is important to ensure effective information exchange. This study aimed to explore women's and nurse midwives' perceptions of their interactions and the information they shared about care during pregnancy and childbirth in Tanzania. Methods: Formative explorative research using in-depth interviews was conducted with eleven Kiswahili-speaking women who had normal pregnancies and had more than three antenatal contacts. Also, five nurse-midwives who worked in the ANC clinic for a year or more were included in the study. A thematic analysis based on descriptive phenomenology guided the analysis of data that was informed by the WHO quality of care framework. Results: Two major themes emerged from the data, enhancing communication and respectful delivery of ANC information and receiving information about pregnancy care and safe childbirth. We found that women felt free to communicate and interact with midwives. Some women feared interacting with midwives and other midwives were difficult to approach. All women acknowledge receiving antenatal care information. However, not all women reported receiving all ANC information as per national and international guidelines. Inadequate staffing and time were the reasons for poor prenatal care information delivery. Conclusion: Women did not report most of the information provided during ANC contacts as per the national ANC guidelines. The inadequate number of nurse-midwives, increased number of clients, and insufficient time were reported to contribute to inadequate provision of information during antenatal care. Strategies for effective provision of information during antenatal contacts should be considered including using group antenatal care and information communication technology. Further, nurse-midwives should be sufficiently deployed and motivated. [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: 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]

Introduction: The use of antenatal care (ANC) plays a major role in minimizing maternal and child mortality through effective and appropriate screening, preventive, or treatment intervention. Even though almost all pregnancy-related mortalities are largely preventable through adequate use of ANC, sub-Saharan Africa (SSA), particularly East African Countries, continues to share the largest share of global maternal, and newborn mortality. Therefore, this study assesses if educational attainment is associated with optimal ANC utilization in East Africa. Methods: A secondary data analysis was done based on Demographic and Health Surveys (DHS) from 2010 to 2018 in the 11 East African Countries. A total weighted sample of 84,660 women who gave birth in the 5 years preceding each country's DHS survey and had ANC visits were included in this study. Data processing and analysis were performed using STATA 15 software. A multilevel mixed-effect logistic regression model was fitted to examine the association of educational attainment and ANC utilization. Variables with a p-value < 0.05 were declared as significant factors associated with ANC utilization. Model comparison was done based on Akaike and Bayesian Information Criteria (AIC and BIC). Results: The magnitude of optimal ANC utilization in East African Countries was 56.37% with 95% CI (56.03, 56.69) with the highest optimal ANC utilization in Zimbabwe (80.96%) and the lowest optimal ANC utilization in Rwanda (44.31%). Women who had higher education levels were more likely to have optimal ANC utilization, compared to those with no education (AOR = 2.34; 95 and CI; 2.11– 2.59). Women who had media exposure were more likely to have optimal ANC utilization than those who have no media exposure (AOR = 1.07; 95% CI; 1.03, 1.10). Conclusion: Antenatal care utilization was low in East African countries. Educational attainment, maternal age, wealth index, birth order, media exposure, and living countries were factors associated with ANC utilization. Efforts to improve antenatal care and other maternal health service utilization in East Africa must take into account these factors. Specifically, working on the access to mass media by women may also improve antenatal care utilization. [ABSTRACT FROM AUTHOR]

Background: Even though antenatal care (ANC) visits seems to be the key strategy to increase adherence to iron and folic acid supplements during pregnancy, the problem still remains unresolved. Therefore, this study planned to assess adherence to iron and folic acid supplements and associated factors among pregnant mothers attending ANC at Gulele sub-city Government Health Centers in Addis Ababa, Ethiopia, 2019. Methods: An institution-based cross-sectional study design was conducted on 403 pregnant women attending ANC at governmental health centers in Gulele sub city of Addis Ababa from May to June, 2019. The study participants were selected by systematic random sampling techniques, and an interviewer administered questionnaire was used to collect data. Descriptive statistics and logistic regression models were used to analyze the data. The results were considered statistically significant at p-value < 0.05. Results: The proportion of mother's adherent to iron and folic acid supplements was 62.3% with a 95% CI of 57.5– 67.0. Women who had no formal education (AOR=2.37; 95% CI=1.25– 4.51), poor knowledge about anemia (AOR=1.97; 95% CI=1.24– 3.13), developing any other health problem during current pregnancy (AOR=2.59; 95% CI=1.55– 4.32), attending health information about iron/folic acid supplement (AOR=2.06; 95% CI=1.08– 3.921 and forgetful (AOR=2.23; 95% CI=1.40– 3.56) mothers were more likely to be non-adherent to the supplement compared with their counterparts. Conclusion and Recommendation: The status of maternal adherence was medium compared with other studies, and maternal educational status, knowledge about anemia, exposure to information, experiencing of health problems, and forgetfulness were associated with adherence behavior. This indicates that improving dissemination of information about the supplements and designing a reminder mechanism was needed to improve the adherence status of mothers to the supplement. [ABSTRACT FROM AUTHOR]

Background: Suicide ideation and attempt are common among pregnant women, risk factors for completed suicide, and associated adverse maternal and fetal outcomes. It is under-recognized and has not been investigated well in low-income countries like Ethiopia. This study aimed to assess the prevalence and factors associated with suicide ideation and attempt among pregnant women attending antenatal care services at public hospitals in southern Ethiopia. Methods: A group of 762 pregnant women who were attending the antenatal service at public hospitals in Hawassa, southern Ethiopia, selected by a systematic random sampling technique, took part in an interview. A Composite International Diagnostic Interview (CIDI) was used to measure suicide ideation and attempt. Chi-square and binary logistic regression analyses were performed to identify the associated factors. An adjusted odds ratio with a 95% confidence interval was used for reporting the result with a p-value< 0.05 statistical significance level. Results: The prevalence of suicide ideation and attempt among pregnant women was 11.8% and 2.7%, respectively. Unplanned pregnancy (AOR=2.01, 95% CI=1.04– 3.88), poor social support (AOR=3.29, 95% CI=1.62– 6.68), common mental disorders (AOR=2.77, 95% CI=1.50– 5.09), and lifetime suicide ideation (AOR=4.63, 95% CI=2.63– 8.16) were factors significantly associated with suicide ideation. Social support was the only correlated factor with suicide attempt among pregnant mothers. Conclusion: The prevalence of suicide ideation and attempt among pregnant women was found to be high. Intervention strategies towards suicidal ideation and attempt should consider improving social support and antenatal related common mental disorders with a primary focus on women with unplanned pregnancy and prior history of suicide ideation. [ABSTRACT FROM AUTHOR]

Background: Regular monitoring and evaluation improves the quality of health services. Client satisfaction is an indicator of the quality of a health service. Poor maternal satisfaction with antenatal care services has negative outcomes. Currently, women's satisfaction with antenatal care services is below standard in low-income countries such as Ethiopia. Therefore, this study aimed to assess women's satisfaction and its associated factors with antenatal care services. Methods: A facility-based cross-sectional study was conducted from September 23 to October 23, 2019. A total of 405 women were involved in the study. A systematic random sampling technique was used. The data were coded manually and checked visually for completeness. The data were entered using Epi Info version 7 and exported to SPSS version 20 for analysis. Descriptive statistic was computed. Thechi-squared test was performed and factors associated with women's satisfaction with antenatal care services were selected for multiple logistic regression at a probability value (p-value) of < 0.2 in the chi-squared analysis. Statistically significant associated factors were identified at a p-value of ≤ 0.05, and with adjusted odds ratios and 95% confidence intervals. Results: Among 405 participants, 53.8% (95% CI=48.7– 59%) of women were satisfied with the antenatal care services. Age of mothers (AOR=6.04, 95% CI=2.3– 15.9), advice on danger signs in pregnancy (AOR=4.53, 95% CI=2.7– 7.52), previous antenatal care visits (AOR=3.8, 95% CI=2.0– 7.52), respectful maternity care (AOR=8.2, 95% CI=3.3– 20.4), and planned pregnancy (AOR=2.8, 95% CI=1.6– 4.8) were statistically significantly associated with women's satisfaction with antenatal care services. Conclusion: About half of the participants were satisfied with the antenatal care services. Age of participants, respectful maternity care, advice on danger signs in pregnancy, previous antenatal care visits, and planned pregnancy were found to be predictors of women's satisfaction with antenatal care services. [ABSTRACT FROM AUTHOR]

Background: The recent coronavirus disease (COVID-19) pandemic has had a disastrous effect on the health-care delivery system, of mainly pregnancy-related healthcare. In order to fill the information gap in the scientific literature and in response to the limited evidence in the country, this study aims to assess the impact of the COVID-19 pandemic on antenatal care utilization among pregnant women attending public facilities in Northeast Ethiopia. Therefore, the result will be beneficial to design strategies for prioritizing maternal healthcare even with the COVID-19 pandemic period. Methods: A facility-based cross-sectional study was conducted from February 2 to August 30, 2020 among pregnant women attending ANC services at public hospitals in Northeast Ethiopia. Thus, a total of 389 women were included in the study with a simple random sampling technique. The bi-variable and multi-variable logistic regression models were employed to identify factors significantly associated with ANC utilization. Adjusted odds ratio (AOR) with 95% CI was estimated to show the strength of association. Finally, a P-value of < 0.05 in the multivariable logistic regression analysis was used to identify predictors of antenatal care utilization. Results: Overall, 114 (29.3%) pregnant women had fully utilized antenatal care services during the pandemic period. Mother age ≥ 35 years (AOR=11.79, 95% CI=1.18– 117.8), secondary education and above (AOR=4.74, 95% CI=1.04– 21.61), history of stillbirth before recent pregnancy (AOR=0.007, 95% CI=0.001– 0.12), interruption and diversion of services due to COVID-19 response (AOR=0.675, 95% CI=0.142– 0.742), fear of COVID-19 (AOR=0.13, 95% CI=0.06– 0.31), and lack of transport access (AOR=4.15, 95% CI=1.04– 16.54) were predictors of full antenatal care service utilization. Conclusion: Three of every ten pregnant women who attended the obstetric outpatient clinics have fully utilized the antenatal care services. Encouraging women's educational status, prioritizing maternal health services during COVID-19, and improving the quality of ANC service should be emphasized more. [ABSTRACT FROM AUTHOR]

Background: While patients' satisfaction is a barometer for healthcare quality, Myanmar did not do enough to assess the antenatal care (ANC) satisfaction. Objective: In this study, we aim to assess the satisfaction level of pregnant women with ANC services provided by a public hospital in Myanmar. Methods: A cross-sectional study was conducted with 125 women in the quantitative and 27 in the qualitative study at South Okkalapa Women and Children Hospital in Myanmar. Satisfaction was measured by using a five-point Likert scale with 25-item services. Statistical software SPSS version 16 was used for quantitative data analysis. Qualitative data were manually analyzed by thematic analysis. Results: The proportion of pregnant women who were satisfied with healthcare services ranged from 18% to 35%. Provider's service yielded satisfaction ranging between 25% and 35%; meanwhile, facilities in the waiting area had the lowest mean score (2.78) for satisfaction. Laboratory service and waiting time at the antenatal clinic were major sources of dissatisfaction. Overall, 48% of the pregnant women were in high satisfaction with ANC services. Out of 25 items, cleanliness of ANC clinic, the process of ANC procedure, drug supply by the hospital, ventilation, and lighting in the waiting area, waiting time to see doctors, and working hours (availability of services) showed significant association with overall satisfaction. Conclusion: Nearly half of the pregnant women in the study were very satisfied with the total healthcare services they received. Facilities in the waiting area, laboratory service, and waiting time to see doctors were dissatisfied services and need to be upgraded. [ABSTRACT FROM AUTHOR]

Background: Antenatal care is one of the strategies for reducing maternal morbidity and mortality directly by affording increased chances of early detection of high-risk pregnancies. WHO recommends a minimum of four ANC visits. In order to make it effective, monitoring of the content and quality of the ANC is needed. However, a number of studies focus on the frequency of ANC, and evidence on core contents of the ANC was limited in this study area. The aim of this study was to determine factors associated with content of the ANC. Methods and Materials: A cross-sectional study design was employed to collect data from a total of 432 respondents by using a semi-structured questionnaire. Data were entered in EpiData version 3.1 and exported to SPSS version 20 for analysis. Both binary logistic regression and generalized linear regression with Poisson type were applied to determine factors associated with frequency of the ANC and core contents of ANC, respectively. Results: The majority of the mothers (78.7%) visited first ANC lately, and 25.2% of mothers attended ≥ 4 ANC visits. Only 17.1% of mothers received all the eight selected elements of ANC services. Predictors of the core contents of the ANC were the frequencies of ANC (AOR: 0.84 (95%CI: 0.76– 0.93), pre-pregnancy utilization of contraception (0.63 (95%CI: 0.55– 0.72)), pregnancy desire (AOR: 0.82 (95%CI: 0.71– 0.94), and birth preparedness and complication readiness (AOR: 0.90 (95%CI: 0.82– 0.98). Conclusion: This study found that low level of WHO minimum recommended ANC and core contents of the ANC. This study suggests that identifying pregnant mothers early increases frequency of the ANC, which improves core content of care. [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]

Background: Antenatal care is a major contributor to the reduction of perinatal and maternal mortality and morbidity, through the identification of high risk pregnancies and early intervention for pregnant women with complications. Inadequate (less than eight contacts) and late antenatal care (starting after 12 weeks) have implications for the health of mothers, fetuses, and newborns. The aim of this study was to assess proportion and determinants of inadequate and late antenatal care among Saudi mothers in Unaizah, Qassim, Saudi Arabia. Methods: This was a cross-sectional study among 537 mothers who gave birth at King Saud Hospital, Unaizah City. Face-to-face interviews were conducted using a structured questionnaire covering sociodemographic information, antenatal care, and determinants that might affect the use of antenatal care. The data were entered into Excel and exported in STATA version 16. Simple and multiple logistic regressions were used to identify the determinants of inadequate and late antenatal care. Results: The mean (standard deviation) age of the participants was 30.71 (5.73) years. The proportion of inadequate and late antenatal care was 34% (95% CI 30– 38) and 25% (95% CI 21– 29). Inadequate antenatal care was independently associated with employed mothers (OR 1.91, 95% CI 1.13– 3.22) and high parity (three or more) (OR 2.21, 95% CI 1.17– 4.16). Late antenatal care was independently associated with employed mothers (OR 1.87, 95% CI 1.07– 3.27) and high parity (OR 2.04, 95% CI 1.01– 4.16). Conclusion: This study found that the proportion of inadequate and late ANC was less than in other regions of Saudi Arabia, but it is still important to decrease this rate. The findings of this study will be useful for policy makers in Qassim region to help them design interventions to target mothers at high risk of inadequate and late ANC. [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]

Background: The maternal morbidity and mortality related to preeclampsia are increasing in developing countries; figures have been estimated to be between 1.8% and 16.7%, including in Ethiopia. However, there is limited research regarding the determinants of preeclampsia in Gedeo Zone. Objective: The aim of the study was to determine the predictors of preeclampsia among pregnant mothers attending ANC and delivery services in southern Ethiopia. Methods: A facility-based unmatched case-control study was conducted in Gedeo Zone. Pregnant mothers attending ANC and delivery service were selected consecutively until the allotted 243 (162 controls and 81 cases) sample size was fulfilled. The collected data were checked for completeness and entered into Epi-data software version 3.1, and exported to statistical package for social science (SPSS) version 20 for analysis. Multivariable logistic regression was employed and a P-value of less than 0.05 with a 95% confidence interval was used to declare the significant association of the independent variables and the outcome variable. Results: A total of 240 mothers, 80 (33.3%) of cases and 160 (66.70%) of controls, responded, with a response rate of 98.76%. The mean age of the participants among both groups was 27.40 with a standard deviation of ± 5.02. Attending education [adjusted odd ratio (AOR) = 0.49; 95% CI (0.006, 0.398)], being a house wife [AOR = 13; 95% CI (1.260, 140.15)], an age range of 20– 34 years [AOR = 0.071; 95% CI (0.015, 0.32)], a family history of diabetes mellitus [AOR = 0.28.2; 95% CI (0.081, 0.985)], a family history of hypertension [AOR = 0.124; 95% CI (0.047, 0.325)], did not eat fruit during pregnancy [AOR = 3.355; 95% CI (1.112, 10.126)], and a maternal history of preeclampsia [AOR = 0.162; 95% CI (0.041, 0.640)] were found to be variables significantly associated among mothers with preeclampsia. Conclusion: The determinant factors for preeclampsia were being a housewife, having a history of hypertension, diabetes mellitus, and preeclampsia among family members. Strengthening early detection and prevention of predictors, improvement of protective factors, and further follow-up study were recommended. [ABSTRACT FROM AUTHOR]

Background: Early antenatal visit is critical for the health and well-being of mothers and babies. However, various individual, family level, and contextual factors influence the timely initiation of antenatal care. Objective: The aim of this study was to examine individual, household, and community-level factors associated with the timing of first ANC visit among mothers who gave birth in the last twelve months before the survey. Methods: A community-based cross-sectional study was conducted in June 2018. A multistage cluster sampling technique was applied, and a sample of 898 women was considered. Data were collected using a questionnaire and checklist. The analysis was made using SPSS. A multilevel logistic regression with random effects at the kebele level was developed to assess the predictors of late initiation of antenatal care. Odds ratio with 95% confidence intervals was used to measure association while the intra-class correlation coefficient and the median odds ratio were used to measure variations. Results: Overall, 78.4% (95% CI: 75.6, 80.9) of women started their first ANC in 4 months of gestation or later and significant heterogeneity was observed between clusters. At level 1, women with intended pregnancy (aOR=0.31; 95% CI: 0.12, 0.79), and being knowledgeable about the timing (aOR=0.43; 95% CI: 0.25, 0.75) and pregnancy-related complications (aOR=0.16; 95% CI: 0.10, 0.26) were less likely to delay their first ANC visit. Conversely, the odds of late ANC visit was higher among women with no formal education (aOR=4.08, 95% CI: 2.20, 7.55). Distance to the health facility (aOR=1.04; 95% CI, 1.01– 1.08) was the only level-2 significant predictor. Conclusion: The study revealed that late ANC initiation was rampant. Several factors operating at different levels were associated with late ANC visits; yet, the role of individual-level factors was relatively stronger. Hence, awareness creation is essential to the underprivileged community using the available communication networks. [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]

Introduction: Thrombocytopenia is a common hematologic abnormality during pregnancy. Pregnant women with thrombocytopenia have a higher risk of bleeding excessively during or after childbirth, particularly if they need to have a cesarean section or other surgical intervention during pregnancy, labor or in the puerperium. The main aim of this study was to determine the prevalence of thrombocytopenia among pregnant women attending antenatal care service at Gondar University Hospital, northwest Ethiopia. Materials and methods: A cross-sectional study was used to assess the prevalence of thrombocytopenia among pregnant women attending antenatal care service at Gondar University Hospital from January to April 2015. A total of 217 pregnant women were included in the study and a structured pretested questionnaire was used to obtain sociodemographic information, nutritional factors, obstetrics and gynecological factors, history and clinical condition. Blood samples were collected for platelet count and other platelet parameters, which were determined by using SysmexKX 21 automation. The data were entered to Epi info version 6 software and analyzed using SPSS version 20 software. Bivariable and multivariable statistical analyses were used to evaluate the effect of independent variable over the dependent variable. A p-value of <0.05 was considered as statistically significant. Result: A total of 217 women receiving antenatal care service at Gondar University Hospital participated in the study. Thrombocytopenia among 19 pregnant women showed a prevalence of 8.8%. The mean ± standard deviation platelet count was 238.85×109/L (±74.57). Thrombocytopenia was significantly associated with patients who lived rurally (crude odds ratio =4.3, 95% confidence interval 1.48-12.76). Conclusion: The prevalence of thrombocytopenia was 8.8% predominantly with mild type of thrombocytopenia. Thrombocytopenia was higher among pregnant women who lived rurally. Therefore, health care providers should screen routinely for thrombocytopenia to avoid excessive bleeding during pregnancy, especially in women who live rurally. [ABSTRACT FROM AUTHOR]

Introduction: Anemia is a global public health problem in both developing and developed countries; ~1.62 billion people suffer from anemia, and pregnant women are the most susceptible to it. The main aim of the present study was to assess the prevalence of anemia and associated risk factors among pregnant women receiving antenatal care at Aymiba Health Center, northwest Ethiopia. Methods and materials: An institution-based cross-sectional study was conducted at Aymiba Health Center from January to March 2015. Hemoglobin level and intestinal parasitic infections in pregnant women were assessed. Sociodemographic data were collected using a structured questionnaire. The data were entered and analyzed using the SPSS version 20. Odds ratio, p<0.05, and binary logistic regression were used to assess the association of pregnant women's sociodemographic characteristics with their hemoglobin levels and the prevalence of anemia. Results: The mean with ±2 standard deviation of hemoglobin value was 12±1.3 (95% confidence interval [CI] =11.9-12.5), and the prevalence of anemia from a total of 206 study subjects was 52 (25.2%). Of this anemic group, 50 (24%) were in the second and third trimesters. Anemia was significantly associated with rural residence and intestinal parasitic infections (adjusted odds ratio [AOR] =9.17, 95% CI =2.15-40, p<0.001) and (AOR =55.091, 95% CI =6.88-441.19, p<0.001), respectively. Conclusion: In the present study, the prevalence of anemia was lower than in previous studies conducted in various countries, including Ethiopia. More studies are needed regarding the importance of regular maternal care and health education promotion programs, which have the potential to play a more significant role in health care. [ABSTRACT FROM AUTHOR]

Background: Maternal health remains a major public health problem in Ethiopia. Despite the government's measures to ensure institutional delivery assisted by skilled attendants, home delivery remains high, estimated at over 80% of all pregnant women. Objective: The study aims to identify determinants that sustain home delivery in Ethiopia. Methods: A total of 48 women who delivered their most recent child at home, 56 women who delivered their most recent child in a health facility, 55 husbands of women who delivered within 1 year preceding the study, and 23 opinion leaders in selected districts of Amhara, Oromia, Southern Nations, Nationalities, and Peoples' Region, and Tigray regions were involved in the study. Key informant interview, in-depth interviews, and focus group discussions were conducted to collect data using checklists developed for this purpose. Data reduction and analysis were facilitated by Maxqda qualitative data analysis software version 11. Results: Findings show that pregnancy and delivery is a normal and natural life event. Research participants unanimously argue that such a life event should not be linked with health problems. Home is considered a natural space for delivery and most women aspire to deliver at home where rituals during labor and after delivery are considered enjoyable. Even those who delivered in health facilities appreciate events in connection to home delivery. Efforts are underway to create home-like environments in health facilities, but health facilities are not yet recognized as a natural place of delivery. The positive tendency to deliver at home is further facilitated by poor service delivery at the facility level. Perceived poor competence of providers and limited availability of supplies and equipment were found to maintain the preference to deliver at home. Conclusion: The government's endeavor to improve maternal health has generated positive results with more women now attending antenatal care. Yet over 80% of women deliver at home and this was found to be the preferred option. Thus, the current form of intervention needs to focus on factors that determine decisions to deliver at home and also focus on investing in improving service delivery at health facilities. [ABSTRACT FROM AUTHOR]

Background: Despite a decade-long armed conflict in Nepal, the country made progress in reducing maternal mortality and is on its way to achieve the Millennium Development Goal Five. This study aimed to assess the degree of the utilization of maternal health care services during and after the armed conflict in Nepal. Methods: This study is based on Nepal Demographic and Health Survey data 2006 and 2011. The units of analysis were women who had given birth to at least one child in the past 5 years preceding the survey. First, we compared the utilization of maternal health care services of 2006 with that of 2011. Second, we merged the two data sets and applied logistic regression to distinguish whether the utilization of maternal health care services had improved after the peace process 2006 was underway. Results: In 2011, 85% of the women sought antenatal care at least once. Skilled health workers for delivery care assisted 36.1% of the women, and 46% of the women attended postnatal care visit at least once. These figures were 70%, 18.7%, and 16%, respectively, in 2006. Similarly, women were more likely to utilize antenatal care at least once (odds ratio [OR] =2.18, confidence interval [CI] =1.95-2.43), skilled care at birth (OR =2.58, CI =2.36-2.81), and postnatal care at least once (OR =4.13, CI =3.75-4.50) in 2011. Conclusion: The utilization of maternal health care services tended to increase continuously during both the armed conflict and the post-conflict period in Nepal. However, the increasing proportion of the utilization was higher after the Comprehensive Peace Process Agreement 2006. [ABSTRACT FROM AUTHOR]

The aim of health education during antenatal is to provide advice, education, reassurance and support, to address and treat the minor problems of pregnancy, and to provide effective screening during the pregnancy. Exploring current practices in this regard revealed the need for more organized educational activities to ensure high quality and clients satisfaction. [ABSTRACT FROM AUTHOR]

Objective: To determine the seroreactivity of pregnant women to syphilis in order to justify the need for routine antenatal syphilis screening. Methods: A multicenter retrospective analysis of routine antenatal venereal disease research laboratory (VDRL) test results between 1 September 2010 and 31 August 2012 at three specialist care hospitals in south-east Nigeria was done. A reactive VDRL result is subjected for confirmation using Treponema pallidum hemagglutination assay test. Analysis was by Epi Info 2008 version 3.5.1 and Stata/IC version 10. Results: Adequate records were available regarding 2,156 patients and were thus reviewed. The mean age of the women was 27.4 years (±3.34), and mean gestational age was 26.4 weeks (±6.36). Only 15 cases (0.70%) were seropositive to VDRL. Confirmatory T. pallidum hemagglutination assay was positive in 4 of the 15 cases, giving an overall prevalence of 0.19% and a false-positive rate of 73.3%. There was no significant difference in the prevalence of syphilis in relation to maternal age and parity (P.0.05). Conclusion: While the prevalence of syphilis is extremely low in the antenatal care population at the three specialist care hospitals in south-east Nigeria, false-positive rate is high and prevalence did not significantly vary with maternal age or parity. Because syphilis is still a serious but preventable and curable disease, screening with VDRL alone, without confirmatory tests may not be justified. Because of the increase in the demand for evidence-based medicine and litigation encountered in medical practice, we may advocate that confirmatory test for syphilis is introduced in routine antenatal testing to reduce the problem of false positives. The government should increase the health budget that will include free routine antenatal testing including the T. pallidum hemagglutination assay. [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]

Background: Maternal mortality rates are unacceptably high in Ethiopia. Institutional delivery with skilled care of the mother is one of the interventions proven to reduce the risk of complications that can cause maternal and neonatal mortality. Quality of service given during antenatal visits and childbirth are important measures. The purpose of this study was to investigate the use of skilled institutional delivery and its repeat use during a subsequent pregnancy and to identify any reasons why women avoid institutional delivery. Methods: A community-based cross-sectional study was conducted from March to June 2012 in Chilga Woreda, Northwest Ethiopia. Data were collected from women who gave birth during the year preceding the survey. Information was entered and cleaned using the Statistical Package for Social Sciences. Multivariate and binary logistic regression was used to identify the relative effect of each explanatory variable on the outcome. Results: A total of 402 (84.2%) women gave birth at home. Previous experience of skilled institutional delivery had a limited role in subsequent acceptance or use of institutional delivery. Most mothers who had previously had institutional delivery gave birth at home. Although 111 (40.8%) women visited the health facility during their pregnancy only because of illness, 184 (38.8%) did not know when to visit for antenatal care. In multivariate analysis, lower maternal education, being a rural resident, previous use of institutional delivery, remoteness of the health facility, and multiparity were factors significantly associated with less likelihood of institutional delivery. Number of months pregnant at the time of the first antenatal visit had no role in increasing the likelihood of institutional delivery. Conclusion: The quality of the obstetric services presently available for women living in Ethiopia needs review. [ABSTRACT FROM AUTHOR]