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Background Pregnant women should be provided with relevant and useful information to manage this specific period of their lives. Assessing information needs of this group is a prerequisite for providing this information. Objective The aim of this study was to assess the information needs of pregnant women during their pregnancy and childbirth. Methods This descriptive study was conducted on the pregnant women who attended antenatal clinics and obstetricians/gynaecologists’ offices in Kerman, Iran, in 2015. Data were collected using a self-administered, valid and reliable questionnaire. A total of 400 women participated in the study. Findings Most pregnant women needed information about care of the foetus (n = 344, 86%), physical and psychological complications after delivery (n = 333, 83%), development and growth of the foetus (n = 330, 82.5%), pregnancy nutrition (n = 327, 82%) and special tests during pregnancy (n = 326, 81.5%). They mostly (n = 195, 49%) looked for information when they were suffering from a disease or pregnancy complications. Conclusions As pregnant women need extensive information to be able to take care of themselves and their babies, their information needs should be identified and taken into consideration when planning educational programmes for this group of women.

Background Coverage with malaria in pregnancy interventions remains unacceptably low. Implementation research is needed to identify and quantify the bottlenecks for the delivery and use of these life-saving interventions through antenatal clinics (ANC). Methods A cross-sectional study was carried out in ANC across nine health facilities in western Kenya. Data were collected for an individual ANC visit through structured observations and exit interviews with the same ANC clients. The cumulative and intermediate systems effectiveness for the delivery of intermittent preventive treatment (IPTp) and insecticide-treated nets (ITNs) to eligible pregnant women on this one specific visit to ANC were estimated. Results Overall the ANC systems effectiveness for delivering malaria in pregnancy interventions was suboptimal. Only 40 and 53 % of eligible women received IPTp by directly observed therapy as per policy in hospitals and health centres/dispensaries respectively. The overall systems effectiveness for the receipt of IPTp disregarding directly observed therapy was 62 and 72 % for hospitals and lower level health facilities, respectively. The overall systems effectiveness for ITNs for first ANC visit was 63 and 67 % for hospitals and lower level facilities, respectively. Conclusion This study found that delivery of IPTp and ITNs through ANC was ineffective and more so for higher-level facilities. This illustrates missed opportunities and provider level bottlenecks to the scale up and use of interventions to control malaria in pregnancy delivered through ANC. The high level of clustering within health facilities suggest that future studies should assess the feasibility of implementing interventions to improve systems effectiveness tailored to the health facility level. Electronic supplementary material The online version of this article (doi:10.1186/s12936-016-1261-2) contains supplementary material, which is available to authorized users.

Background: Viral infections are common in pregnancy and have been associated with poor pregnancy outcome. In many developing countries including Tanzania, the magnitude of these infections and their impact to pregnancy outcome is not clearly understood. The aim of this study was to determine the magnitude of these infections. The information from this study may influence policy makers to consider routine screening of these infections during antenatal visits. Methods: A cross sectional hospital based study involving 214 pregnant women was conducted between December 2014 to and August 2015 in two antenatal clinics in Mwanza city. Rubella, cytomegalovirus and parvovirus B19 (B19) specific IgG and IgM antibodies were detected by using commercial indirect enzyme linked immunosorbent assay. Data were analyzed using STATA version 11. Results: The median age of enrolled pregnant women was 21 (Interquartile range: 20-26) years. Previous co-infections of rubella, cytomegalovirus and B19 was detected in 78 (36.5%) of pregnant women tested. A total of 20 (9.4%) pregnant women had acute co-infection of rubella and parvovirus B19 while 1(0.5%) had acute co-infection of cytomegalovirus and parvovirus B19. The odds of having previous co-infection (IgG sero-positivity) increase significantly as the age increases (odd ratio: 1.056, 95% CI: 1.00-1.11, P=0.03). Moreover, as the gestation age increases the odds of having co-infection decreases significantly (odd ratio: 0.923, 95% CI: 0.88-0.96, P=0.001). Conclusion: Considerable proportion of pregnant women in Mwanza is co-infected with rubella, Cytomegalovirus and parvovirus B19. We recommend routine screening for these infections during antenatal visits so as to reduce the possibility of congenital infection.

Objective To evaluate the accuracy of the Omron MIT Elite in pregnancy and pre-eclampsia according to the British Hypertension Society protocol (BHS). Design Prospective observational study. Setting Antenatal clinics and wards at St. Thomas’ Hospital (London, UK). Population Forty-five pregnant women including 15 with pre-eclampsia. Methods Nine sequential same arm blood pressure (BP) measurements were taken from each woman by trained observers, alternating between mercury sphygmomanometry and the test device. Main outcome measures Grading criteria of the BHS protocol (A/B grade = pass; C/D = fail). Results The Omron MIT Elite achieved a grade A/A in both pregnancy and pre-eclampsia. The mean difference (SD) between the mercury standard and the device in pregnancy was −1.1 (5.2) mm Hg and 1.5 (4.8) mm Hg for systolic and diastolic BP respectively compared to 0.2 (5.3) mm Hg and 2.2 (5.5) mm Hg in pre-eclampsia. Conclusion The Omron MIT Elite can be recommended for use in pregnancy and pre-eclampsia according to the BHS protocol. To date, this is the most accurate automated BP device validated in pre-eclampsia.

Background Current evidence suggests that fetal movements are an important indicator of fetal well-being. About a quarter of women who present with decreased fetal movements have adverse perinatal outcomes such as intrauterine growth restriction and stillbirth. There are no New Zealand studies reporting maternal knowledge about fetal movements in late pregnancy. Aims To determine what information women in the third trimester of pregnancy receive about fetal movements, both from their maternity caregivers and from other sources. Methods A convenience sample of 100 women attending two antenatal clinics in Auckland in November and December 2011 were interviewed by a medical student. Results Ninety-seven per cent of women reported that their lead maternity carer (LMC) regularly asked about fetal movements, and 62% recalled receiving information from their LMC about what to expect regarding fetal movements in the last three months of pregnancy. Thirty-three per cent recalled receiving information from their LMC that their baby's movements should increase or stay the same and 20% that their baby's movements may decrease in late pregnancy. Forty per cent were advised to contact their LMC if they had any concerns about their baby's movements, and one-quarter were informed to seek advice if they had fewer than 10 movements in a day. Conclusions Our study suggests a proportion of pregnant women in Auckland do not have optimum information about fetal movements. Strategies to enhance maternal knowledge such as a pamphlet about fetal movements may be helpful.

Mother to child transmission is the major cause of HIV infection in children. This quantitative study was aimed at identifying the factors that influence mothers notifying their partners of their HIV status after undergoing routine HIV testing at antenatal clinics in Kalomo district, Zambia. A total of 120 antenatal mothers were interviewed. The study revealed that participants who had positive cultural practices, were married, in the same relationship for more than 5 years, had prior discussion with the partner about testing, and knew their partner's HIV status were more likely to notify their partners about their HIV status. Midwives will be able to use these factors to increase the women's HIV status notification rate and participation in preventive programmes by identifying women who are unlikely to notify their partners and help them to do so.

We have reviewed a history of prophylactics development as a branch of maternity and child care in the republics of Northern Caucasus. We follow the development of this service from 1924; we make parallels between system of antenatal clinics development, that aimed at medical and sanitary literacy growth of the population, the development of system of regular medical check-ups of pregnant women in the country in general.

Introduction: HIV causes morbidity and mortality in infants and children, pertaining to its mother- to-child transmission (MTCT) risk. MTCT which occur during pregnancy, labour and breastfeeding, is responsible for 90% childhood HIV infection. The main objective of the prevention of mother-to-child transmission (PMTCT) is to reduce the transmission of HIV infection from HIV infected mothers to their off springs. AIM:Our objective was to determine the level of HIV/AIDS knowledge of pregnant women. Methods: This study was done on pregnant mother at the antenatal clinic at Shri Vasantrao Naik Government Medical College & hospital (SVNGMC). One hundred and fifty mothers were interviewed at the antenatal clinics. It is non-experimental, cross-sectional type of study. Statistical Analysis:Comparison of categorical data with education and occupation was done using the Chi-Square test. Results: Out of 150, most of the women belongs to 21-25yrs age group (54.00 %),55.34 %were housewife. 95.34 %were literate. Television & radio were more strongly related to knowledge of HIV/AIDS. 77.34 % mother knew that it is transmitted by sexual route and 22.66 % mother did not know the transmission of HIV/AIDS. CONCLUSION: Education and correct scientific information are urgently needed to pregnant women to avoid myths and misconception on HIV/AIDS.

This paper presents an application of Multi-layer Perceptrons (MLP) neural networks to model the demographic characteristics of antenatal clinic attendees in South Africa. The method of cross-validation is used to examine the betweensample variation of neural networks for HIV prediction. MLP neural networks for classifying both the HIV negative and positive clinic attendees are developed and evaluated using validity and reliability of the test. Neural networks are robust to sampling variations in overall classification performance.

More than 90% of pregnant women take prescription or non-prescription drugs at some time during pregnancy. In general, unless absolutely necessary, drugs should not be used during pregnancy because many of them are harmful to the fetus. Appropriate dispensing is one of the steps for rational drug use; so, it is necessary that drug dispensers should have relevant and updated knowledge and skills regarding drug use in pregnancy. To assess the knowledge of drug dispensers and pregnant women regarding drug use in pregnancy, focusing on four commonly used drugs that are teratogenic or cause unwanted effects to the fetus and babies. The study was conducted in two parts: consumers' perception and providers' practice. It was a cross-sectional study involving visits to 200 private retail community pharmacies (as simulated client) within Temeke, Ilala and Kinondoni municipals in Dar es Salaam, Tanzania. The second part of the study was conducted at the antenatal clinics of the three municipal hospitals in Dar es Salaam. A semi-structured questionnaire was used to gather information from pregnant women. In total, 200 pregnant women were interviewed. Out of 200 drug dispensers, 86 (43%) were willing to dispense artemether-lumefantrine (regardless of the age of pregnancy), 56 (29%) were willing to dispense sodium valproate, 104 (52%) were willing to dispense captopril and 50 (25%) were willing to dispense tetracycline. One hundred and thirty-three (66.5%) pregnant women reported that they hesitated to take medications without consulting their physicians, 47 (23.5%) indicated that it was safe to take medications during pregnancy, while 123 (61.5%) mentioned that it was best to consult a doctor, while 30 (15%) did not have any preference. Sixty-three (31.5%) women reported that they were aware of certain drugs that are contraindicated during pregnancy. It is evident that most drug dispensers have low knowledge regarding the harmful effects of drugs during pregnancy. Drug dispensing personnel should be considered part of the therapeutic chain and, if appropriately trained, they will play a very important role in promoting rational use of medicines.

The purpose of this study was to understand the process of Thai men becoming a first-time father. Twenty expectant fathers were voluntarily recruited from the antenatal clinics of three hospitals in Chiang Mai, northern Thailand. The data were collected by in-depth interviews and analyzed on the basis of grounded theory methodology. The findings demonstrated that "protecting the unborn baby" was the basic social process that emerged as the core category. This process was divided into three phases: confirming and accepting, perceiving the unborn baby as a human being, and ensuring the health of the mother and baby. Throughout this process, the Thai expectant fathers applied many strategies to manage their concerns, needs, and emotions and to develop themselves into fathers. The process of protecting the unborn baby provides insight into the expectant fathers' experiences, which will enable nurses and midwives to assist and care for men as they become fathers.

A study co-infection of malaria and typhoid fever among pregnant women attending antenatal clinics at General Hospital Wuse, Federal Capital Territory (FCT), Abuja, Nigeria, between March and May, 2015. Blood samples were obtained from the pregnant women by venipuncture technique and 4ml of whole blood collected and placed into EDTA bottle for malaria parasite and typhoid fever examination. A total of 200 pregnant women were examined. Field stained thick and thin blood films were used to detect malaria parasites in the samples while typhoid fever was diagnosed from each blood sample using Widal test kit. Out of the 200 persons sampled, 16(8.0%) tested positive for malaria, 86(43.0%) tested positive for typhoid fever. Co-infection of malaria and typhoid fever was highest in the age-group of 31-40 years, 8(11.11%) while͵≤ 20, 21-30 and 51-60 age-groups recorded no co-infection. Statistically, there is a significant difference on malaria-typhoid co-infection. There is need for massive health education campaign to educate the pregnant women who visit General Hospital, Wuse, to correct the wrong perception they have about malaria and typhoid fever for effective treatment and control of the diseases.Keywords: Malaria; typhoid fever; co-infection; Wuse.

This study was conducted to determine the knowledge and practice of pregnant women attending specialist antenatal clinics (ANCs) concerning malaria, ITN (insecticide-treated net) utilization and antimalarial treatment. The study recruited 225 women who voluntarily presented at ANCs in Jimma town, Ethiopia. A pre-tested questionnaire was administered. A great majority (98.2%; 221/225) of the respondents were aware of malaria. Among them, 77.4% (174/225) indicated mosquito bites as a mode of malaria transmission. Overall, 94.3% (212/225) and 98.3% (221/225) of pregnant women had knowledge about ITNs and antimalarials, respectively. Overall, 76.8% (173/225) and 57.4% (129/225) of the study participants erroneously indicated mosquito bites and stagnant water as causes of malaria, respectively. In general, the majority of pregnant women were unable to distinguish between malaria transmission and cause. Chi-square analysis revealed a strong association between the educational status of the pregnant women and their daily usage of ITNs (P = 0.001; χ2 = 22.9; df = 8). The results clearly suggest that although the majority of the pregnant women had ample awareness of malaria, ITN usage and antimalarial treatment, a sizable faction still had misconceptions and misunderstandings. Therefore, appropriate communication strategies should be designed and implemented among the marginalized and most vulnerable section of society, especially through health education campaigns, in order to have a constructive outcome in the near future.

The study examined factors associated with intimate partner violence (IPV) among pregnant women in rural Uganda. The Conflict Tactics Scale was used to collect data from 120 pregnant women attending antenatal clinics in a rural county of Uganda. Results show that 26% of the participants experienced IPV during the current pregnancy. The most common forms of violence were verbal aggression (48%) and minor violence (39%). IPV was associated with women's age, number of children, parity, and level of education. IPV was also associated with having a male partner who has multiple intimate partners, beliefs that a violent male partner should not be reported to legal authorities, and knowing someone with a violent partner. IPV during pregnancy is a major health problem in rural Uganda and this problem can be addressed through integration of IPV screening, counselling, treatment and legal referrals in all reproductive health services for pregnant women in rural Uganda.

Summary Objective To describe the factors associated with malaria infection and anaemia in pregnancy in northern Ghana. Method We studied 3642 pregnant women of all gravidities and gestational age of 18–32 weeks who attended an antenatal clinic in the Kassena-Nankana district of Ghana between June 2004 and July 2006. Blood samples were examined for haemoglobin concentrations and parasitaemia, and we obtained socio-demographic data, an obstetric history, information on their past and current state of health and bed net use. Results The overall prevalence of malaria parasitaemia during pregnancy was 47%. Older age [adjusted odds ratio (AOR) 0.65, 95% CI 0.54–0.78], multigravidity (AOR 0.51, 95% CI 0.42–0.61) and third trimester of pregnancy (AOR 0.85, 95% CI 0.73–0.99) were associated with a decreased risk of parasitaemia. Enrolment during the rainy or post-rainy season was associated with an increased risk of parasitaemia (AOR 2.59, 95% CI 2.20–3.04 and AOR 3.12, 95% CI, 2.60–3.74 respectively). Malaria infection was associated with an increased risk of anaemia among young women. The prevalences of anaemia (Hb

The influence of social support, work overload, and parity on psychological well-being of pregnant career women was investigated. Women executives (N200) attending antenatal clinics were selected. A 2 ¥ 2 ¥ 2 analysis of variance (ANOVA) revealed significant independent influence of social support (F (1, 199) = 26.51, p 0.05). Combinations of parity, social support, and work overload were also not significant (F(1, 199) = 0.80, p > 0.05). Social support and appropriate work incentives are helpful in assisting pregnant women executives in coping with psychological changes during pregnancy.

Background Smoking during pregnancy increases the risks of many pregnancy-related complications. MiQuit is a tailored, self-help, text-message intervention developed to help pregnant smokers to stop. A pilot RCT investigated feasibility of recruitment of women attending hospital antenatal clinics by using NIHR Clinical Research Network (CRN) research midwives (RMs); findings will be used to plan a future definitive trial to investigate MiQuit efficacy. We aimed to describe the facilitators and barriers to trial recruitment that RMs perceived, and relate these to key recruitment processes.

Introduction: World Health Organization estimates that deaths resulting from diabetes will rise above 50% by the year 2020; hence urgent action is needed to reverse the trend notably through nutrition and lifestyle intervention among populations at risks. Studies have established that nutritional environment and physiology of the mother affects neonate's health at infancy and later in life thus this study sought to investigate the risk factors for development of gestational diabetes focusing age, weight, family history and pre-existing medical condition which could be modified to improve population health. Methods: a retrospective cohort study design was used. Subjects were sampled from selected maternity facilities in Nairobi and were subjected to oral glucose test to ascertain Gestational Diabetes mellitus (GDM) status. A questionnaire was administered to a sample of 238 respondents. Quantitative data was then analyzed as descriptive statistic, univariate and multivariate regression. Results: average age for mothers with GDM was high with a mean of 33.06 (95% C.I: 31.59-34.52) compared to a mean of 27.9 (95% C.I: 27.01-28.78) for non- GDM mothers. Weight before pregnancy was high with mean of 74.04 (95% C.I: 70.82-77.30) among mothers with GDM compared to mean of 60.27 (95% C.I:58.59-61.96) among non-GDM mothers. Mothers with diabetic history in the family had twice the risk of developing GDM (OR= 2.27; 95% C.I: 1.23-4.17) compared to those who did not observe diabetic history in the family. Conclusion: gestational diabetes cases are relatively high. Age advancement; high weight and diabetic history in family are determining factors for development of diabetes among pregnant women. The Pan African Medical Journal 2016;24

Background Obstetric emergencies need prior preparation. ‘Birth Preparedness and Complication Readiness9 (BPCR) is a concept that promotes timely maternal care. Objectives This study assessed BPCR and associated factors among pregnant women attending antenatal clinics (ANCs) in MOH area Padukka. Methods A descriptive cross-sectional study was carried out in 2014, among a random sample of 280 third trimester pregnant women, attending ANCs in MOH area Padukka. Data were collected using a pre-tested interviewer administered questionnaire. Satisfactory BPCR was if accomplished ≥6 components of 8; desired place of birth, closest care facility, birth-related expenses, emergency expenses, person to accompany, arrangements to look after other children, transport for birth, transport in an obstetric emergency. Result Response rate was 95.9% (n=269). Median age was 29 years (IQR; 25–32). Pregnancy was planned by 84.0% (n=226), 81.0% (n=218) had registered with PHM ≤8 weeks, 58.4% (n=157) had attended ≥5 ANCs, 10.8% (n=29) had attended all ante-natal classes, 75.8% (n=204) had discussed BPCR plan with healthcare provider. Only 60.2% (n=162) had satisfactory knowledge on pregnancy, delivery and post-partum danger signs, 75.0% (n=207) had favourable attitudes towards BPCR, 68.6% (n=185) had favourable perceptions on BPCR services. Of them 86.2% (n=232) had satisfactory BPCR which was significantly associated with planned pregnancy, registration ≤8 weeks, ≥5 ANCs, ≥1 antenatal classes, discussing BPCR plan with healthcare provider, knowledge on pregnancy and post-partum danger signs, favourable attitudes and favourable perceptions (p Conclusion Knowledge on danger signs and attitudes towards BPCR need improvement. Sustainable, culturally sensitive BPCR practice models are needed.

Background: Despite increases in obesity among children under 2 years, few interventions have targeted this age group. Mothers and Others (MO preliminary longitudinal cohort of 217 AA mother-infant dyads; and, 20 semi-structured interviews with AA moms, dads and grandmothers. Results: The trial will be conducted among 468 AA mothers recruited through antenatal clinics. Intervention mothers will identify a study partner to participate with her. Delivery channels include face-to-face peer counseling through 6 home visits, support from a lactation consultant, 6 newsletters, and twice weekly text messages. Outcomes include differences in weight-for-...

As countries consider a wider use of triple antiretroviral therapy (ART) in pregnancy, which in recent World Health Organization guidelines is called Option B+, this study sought to explore the potential implications of adopting Option B+ by characterizing HIV infection in pregnant women attending 2 semiurban antenatal clinics in Cameroon. In a descriptive cross-sectional study, consenting women were screened for HIV; positive samples were confirmed using an enzyme-linked immunosorbent assay test, and CD4 levels and HIV viral loads were determined using flow cytometry and reverse transcription–polymerase chain reaction, respectively. The seroprevalence of HIV in the 407 pregnant women screened was 8.4% (95% confidence interval: 5.9%-11.5%). The majority (82.4%) of HIV-positive women had CD4 counts >350 cells/mm3. A quarter (25%) had undetectable viral levels (

An anonymous questionnaire was sent to the lead consultant obstetricians and the midwives in charge of the antenatal clinics of all maternity units in UK to determine their current views on the diagnosis and management of obstetric cholestasis (OC). The response rate was 60%. Management policies were broadly similar and consistent with those recommended in the current literature. However, the survey highlighted areas for improvement. Based on the findings of this survey, a consensus view of the management of OC in UK is achievable.

Concomitant to demographic transition from high to low fertility and mortality is the structural change from a youthful to an ageing population. The change raises, among others, intergenerational demographic, economic and social issues, some of which have been perceived as problems. The HIV/AIDS epidemic poses additional challenges to policy makers in the provision of personal care and financial support as it may alter intergenerational relationships in the demand for services in transitional populations. The first HIV/AIDS case in South Africa was reported in 1981. Since then, HIV sero-prevalence as measured by women attending antenatal clinics has steadily increased in the country, and currently South Africa is one of the highest HIV prevalent countries in the world and in the African continent with sero-prevalence of 29.5% among pregnant women attending antenatal clinics in 2004. In 2002, the Nelson Mandela Funds in collaboration with the Human Sciences Research Council carried out a national ...

The prevalence of sexually transmitted infections (STIs) was assessed in 766 apparently healthy, pregnant urban South African women presenting for delivery, and associations with demographic and socio-economic characteristics and clinical symptoms were determined. Overall, 48% of women carried one or more STI infection during their pregnancy. Infection with HIV, Treponema pallidum, Chlamydia trachomatis and Neisseria gonorrhoeae was detected in 18%, 23%, 12% and 9% of women, respectively. Predictive factors for infection included lack of antenatal care, multiple pregnancies, being unmarried, unemployed status and lack of a regular monthly income. While routine screeing for HIV and at most South African antenatal clinics, screening for chlamydial and gonococcal infection is not routinely performed and therefore these infections remain undetected and untreated. Elicited symptoms were not associated with infection, but differences in demographic and socio-economic characteristics offer a tool to tailor preve...

This preliminary study tested the hypothesis that older primigravidas feel emotionally more stressed during pregnancy than younger primigravidas. Two groups of 30 women were assessed using the GHQ‐12 self‐report questionnaire. Cases were primigravidas aged 35 or older, controls were primigravidas aged 20–30. The sampling frame was divided into three groups of 10 women, each group representing one of the three pregnancy trimesters. The study demonstrated the feasibility of using the GHQ‐12 questionnaire in antenatal clinics. Older primigravidas took more time in antenatal consultations. No significant difference was found between the groups of women, although a small number in both were very anxious. Qualitative data obtained from an open‐ended question revealed pregnancy‐related anxieties in approximately half of the women.

Background. Public antenatal care (ANC) clinics in Sweden contribute to low prenatal mortality and morbidity, through early detection of somatic risk factors, and referral to appropriate specialized care. Available statistics indicate, however, that this system is ineffective in dealing with psychosocial health problems, such as hazardous drug and alcohol use. Factors underlying this failure have not been explored. Methods. An anonymous survey was carried out among all 207 ANC midwives in Stockholm County to establish their level of training within this problem area, clinical experience, theoretical clinical strategies, and actual clinical actions. Findings. Responses indicate that ANC midwives: 1. are well aware of the health hazards of drug and alcohol use during pregnancy; 2. confirm having met and cared for subjects with hazardous substance use; 3. are familiar with specialized care resources available for this patient category; 4. make adequate choices regarding clinical action, i.e. problem identifi...

The development and implementation of a model of midwifery-led antenatal care was the second phase of a larger project known as the Improving Patient Outcomes Project. The overall project aim was to demonstrate the effectiveness of evidencebased models and systems of care on improving patient outcomes. Survey results from local antenatal clinics had revealed an absence of evidence-based guidelines for the provision of antenatal midwifery care. Midwives and expert reviewers combined their experience to appraise the quality and relevance of currently available research evidence to develop a best practice model of antenatal care for low risk women in which the midwife is the lead antenatal care professional. The model offered a care plan for the pregnancy trimesters and outlined circumstances requiring referral to, or consultation with, a medical officer. In addition it offered women a flexible visit schedule and continuity of carer throughout the antenatal period. The methods used in this study may have general applicability to developing best practice models of antenatal care and for the validation of contemporary midwifery antenatal practice. The value of the model will be realised through its successful implementation by the midwifery profession and the evaluation of its effectiveness for women and their families.

To study the prevalence and predictors of physical abuse among pregnant women in Pattani Hospital, Pattani, Thailand. A total of 611 women receiving antenatal clinic services through Pattani Hospital between July 1, 2002 and November 21, 2002 were interviewed. Information was collected on the women’s sociodemographic characteristics, experience of abuse, demographic characteristics of their partners, partner’s smoking habit and use of alcohol. The women’s experience of abuse was assessed by a questionnaire modified from the Abuse Assessment Scale (AAS). In all, 99 (16.2%) women reported experiencing past physical abuse (during a prior pregnancy or during the preceding year), 24 (3.9%) reported experiencing physical abuse during their current pregnancy, and 58 (9.5%) reported experiencing physical abuse both in the past and during their current pregnancy. Physical abuse was associated with parity, marital status, length of relationship, women’s education, smoking habit and the use of alcohol by their partner. After adjustment for confounding factors, the strongest risk factor for physical abuse during pregnancy was partner with a drinking problem. Women whose partner had a drinking problem were more likely to experience abuse during their current pregnancy than those whose partners did not have a drinking problem. In this study, one in eight pregnant women experienced physical abuse during current pregnancy. All types of abuse should be routinely ascertained in antenatal clinics.

Objective: To evaluate the effectiveness of iron and folate supplementation in antenatal clinics.

Objective: To know the principal characteristics associated to adolescent pregnancy and value it as a possible risk factor for low birthweight. Materials and methods: To study cases and controls for six months. The cases were selected from nuliparous women aged from 14 years to 19 years admitted to obstetrics during labour. The controls, nuliparous women aged 20 years or more, were admitted to the same center during the same period of time and were chosen randomly from the admissions book. These were coded and later processed using the data of the SPSS V 11.0 programme; descriptive analysis of the data was made, OR was calculated as the measurement of association, with an CI of 95% and the Chi squared test as a contrast of the hypothesis, and assuming the value p < 0.05 to be the statistically significant difference between them. A multivariant analysis was also carried out using a multiple logistic regression model. Results: 242 cases and 484 controls. The risk factors associated with low birth weight identified in the analysis were: the age of the mother < 19 years OR 2.12; CI (1.30-3.44) and antenatal control < 5 visits, OR 5.15 (2.81-9.41). Generally speaking the adolescent mothers were out of the education system and mostly worked as domestic assistants, they also had a higher incidence of low birth weight and prematurity. Conclusions: There is an association between the age of the mother and low weight neonates, which increases amongst those who do not attend the antenatal clinics regularly.

Randomized controlled trials have provided evidence that antenatal perineal massage is effective in reducing perineal trauma. The provision of information on antenatal perineal massage was introduced as a new service for women and a series of training sessions were held to teach perineal massage to midwives working in antenatal clinics. This article includes a literature review on perineal massage and an evaluation of the massage training. Midwives' views on perineal massage and the training they received were obtained through questionnaires and focus group discussions. The response to perineal massage was varied, with some midwives actively promoting the service while others had no interest in the project and did not give information on antenatal perineal massage to their women. Although just under half of all eligible women received information on perineal massage, an audit of perineal trauma rates found a 6% reduction in perineal trauma since the introduction of the new service.

During a three-year period a total population of pregnant women attending antenatal clinics in Link÷ping, Sweden was screened for being at psychosocial risk. The prevalence of different psychosocial risk factors was compared with the corresponding prevalence in women referred to and accepting or declining to take part in a specialised training programme at a parent-baby clinic. In general, the present study showed that there was a constant proportion of about 4-5% of pregnant women with psychosocial risk factors. Psychiatric problems and social problems of relevance for pregnancies/parenthood were about equally frequent (i.e. 44 and 45%), while drug-addiction problems were at 11%. Only one in three women with risk factors were eventually referred to the parent-baby clinic, and every second woman referred finally took part in the programme. With the knowledge that an early intervention in families with psychosocial risk factors may alleviate some adverse or disadvantageous developments in children, it is a challenge to identify and to motivate these women to enrol in various support and training programmes. There are still too few pregnant women at risk who are ready to accept the further support that they may need, and the rationale for their reluctance must be better known.

From antenatal clinics in Sweden, 271 women were recruited after week 33 of pregnancy and given a questionnaire designed to assess their attitudes and feelings about the coming childbirth. Thereafter, they formulated a birth plan. The midwife in attendance at the birth was able to refer to this plan. Women who followed this program were compared with women from the same clinics who were asked to complete a questionnaire during the first postpartum week to assess their birth experience. A questionnaire at the end of pregnancy, followed by a birth plan, was not effective in improving women's experiences of childbirth. In the birth plan group, women gave significantly lower scores for the relationship to the first midwife they met during delivery, with respect to listening and paying attention to needs and desires, support, guiding, and respect. Although a birth plan did not improve the experience of childbirth in the overall group, there may be beneficial effects with regard to fear, pain, and concerns about the newborn for certain subgroups of women.

Objective. To evaluate the use of an Internet-based information system on infectious disorders (INFPREG) in antenatal care in Sweden. Methods. A postal questionnaire was sent to all antenatal clinics in Sweden in 2000 ( n = 515) and 2002 ( n = 503). The questionnaire consisted of sections covering use of computers, availability of Internet connections and the use of INFPREG in patient care. Results. We received 404 completed questionnaires in 2000 and 501 in 2002. In 2000, 81% of the midwives had access to computers at their antenatal clinics, and this number had increased to 93% in 2002. Sixty-eight percent and 88% in 2000 and 2002, respectively, had computers with an Internet connection. Of the responding midwives, 74% in 2000 and 84% in 2002 had received information concerning INFPREG. In 2000, 29% of the midwives had visited INFPREG and this figure had increased to 58% in 2002. Of the midwives that had used INFPREG, 67% in 2000 and 81% in 2002 reported that the information obtained from the site was i...

This study was conducted to assess factors that influence use of antenatal care services with both quantitative and qualitative designs. Methods used were structured questionnaire interviews and focus group discussions in the Kampung District, Kampot Province in Cambodia with a volunteer sample of 260 postnatal mothers. The outcome measure was factors influencing use of antenatal care services. The results showed that first-time mothers (primigravidas) were more likely to use antenatal services than multiparous mothers (OR = 1.87; p = 0.001). Mothers with some school education used antenatal services more than those with no school education (OR = 2.0; p = 0.01). Mothers engaged in professional occupations by virtue of their higher levels of educational attainment were more likely to use antenatal services than those engaged in agriculture (OR = 2.54; p = 0.001). Use of antenatal care services was higher in the districts whose health centers were supported by a foreign nongovernmental organization as compared to other districts with no such support (OR = 2.44; p = 0.001). Although services were generally inadequate, those that existed were underutilized by the mothers. Major factors influencing use of services include distance, lack of transport, and lack of awareness of the benefits of antenatal care by the mothers, thus resulting in a general notion that antenatal care is only important when problems occur during pregnancy. It is concluded that for remote villages, mobile antenatal clinics should be provided to improve access, and greater emphasis should be placed on health educating the mothers about the potential benefits of antenatal care, with special attention to multiparous mothers and those from the lower socio-economic class, among whom use of antenatal services was lowest.

Objectives: to investigate Swedish midwives' perceptions and attitudes towards infibulation and infibulated women, midwives' experiences of providing care for them and the training the midwives describe having received to enable them to care for and deliver infibulated women. Design: a multi-stage sampling procedure was used. Open-ended questionnaires were distributed to midwives in labour wards with the purpose of identifying midwives to contact for interviews and focus group discussions. Setting and participants: twenty-six midwives from three labour wards and two antenatal clinics situated in two towns in central Sweden participated in eight focus group discussions and three individual interviews. Findings: there were three major themes: (a) emotions and communicational challenges entailed in the care of infibulated women, (b) knowledge and skills needed for caring and (c) the midwives' reliance on the Swedish law when dealing with the dilemmas they face in their interactions with the women and their families. The data indicate communication problems on different levels between midwives and the women and their families. There appear to be few or no guidelines in the units on how to provide good care for infibulated women and little or no co-ordination between antenatal care and the maternity wards. Key conclusions and implications for practice: the care of infibulated women during pregnancy and childbirth seems to be a marginalised issue in the areas where this study was performed. Early acknowledgement of female genital mutilation during pregnancy as well as improved communication between health care units may help professionals to offer culturally sensitive professional care to the women and their families.

Kenya's National Malaria Strategy states that insecticide-treated nets (ITNs) would be considered as a free service to pregnant women assuming sufficient financial commitment from donors. In 2001, United Nation's Children's Fund (UNICEF) and the Government of Kenya brokered support to procure and distribute nets and K-O TABs (deltamethrin) to 70 000 pregnant women in 35 districts throughout Kenya around Africa Malaria Day. This intervention represented the single largest operational distribution of ITN services in Kenya to date, and this study evaluates its success, limitations and costs. The tracking process from the central level through to antenatal clinic (ANC) facilities suggests that of the 70 000 nets procured, 37 206 nets (53%) had been distributed to pregnant women throughout the country within 12 weeks. One-fifth of the nets procured (14 117) had gone out to individuals other than pregnant women, most of these at the request of the district teams, with only 2870 nets estimated to have gone astray at the ANC facilities. At 12 weeks, the remaining 18 677 nets were still in storage awaiting distribution, with more than two-thirds having reached the district, and nearly half already being held at ANC facilities. The cost of getting a net and K-O TAB to an ANC facility ready for distribution to a pregnant woman was US$ 3.81. Accounting for the 14 117 nets that had gone to other users, the cost for an ITN received by a pregnant woman was US$ 5.26. Delivering ITNs free to pregnant women through ANCs uses an existing system (with positive spin-offs of low delivery cost and simple logistics), is equitable (as it not only targets those who can afford it) and can have the added benefits of strengthening ANC service, delivery and use.

Since the late 1980s, human immunodeficiency virus (HIV) sentinel serosurveillance among pregnant women attending select antenatal clinics (ANCs) based on unlinked anonymous testing (UAT) has provided invaluable information for tracking HIV prevalence and trends and informing global and national HIV models in most countries with generalized HIV epidemics. However, increased coverage of HIV testing, prevention of mother-to-child transmission (PMTCT), and antiretroviral therapy has heightened ethical concerns about UAT. PMTCT programs now routinely collect demographic and HIV testing information from the same pregnant women as serosurveillance and therefore present an alternative to UAT-based ANC serosurveillance. This paper reports on the evolution and current direction of the global approach to HIV surveillance among pregnant women attending ANCs, including the transition away from traditional UAT-based serosurveillance and toward new guidance from the World Health Organization and the Joint United Nations Programme on HIV/AIDS on the implementation of surveillance among pregnant women attending ANCs based on routine PMTCT program data.

Background: Gestational hypertension is a significant threat both to maternal and fetal health. However, it is still a distant dream to predict accurately its occurrence in early pregnancy. Objective was to find out if β HCG levels determined between 13 to 20 weeks of gestation can be used as a predictor for gestational hypertension.Methods: This prospective observational cohort study was conducted from August 2014 to January 2016. Serum β HCG levels were determined at 13 to 20 weeks of gestation of 190 normotensive pregnant women attending the antenatal clinics. They were followed for the development of gestational hypertension till 40 weeks of gestation or delivery.Results: Out of the total 190 women, 25 (13.1%) developed gestation hypertension. Of those who developed gestational hypertension, 22 (88%) were having β HCG levels >2 MOM (p2 MOM were 83.3, 96.9, 80.0 and 97.5 respectively (95% CI).Conclusions: Pregnant women with high Beta HCG levels in early pregnancy have significantly higher risk for development of gestational hypertension.

The caesarean section (CS) rates have increased continuously all over the World during the last decades. The reasons for the rising numbers of CS probably have several different explanations Parents to be are influenced by trends in society and the vast possibilities to gain information from different media on pregnancy and delivery methods and outcome. This is assumed to have an impact on the consumer's preferences for mode of delivery (Anderson GM, 2004). Both patients and professionals may nowadays have a more liberal attitude towards CS. The aim of the study was to assess the attitude towards mode of childbirth among primigravida women in selected antenatal clinics of Mangalore. A descriptive survey approach was adopted for the study. Sample of 200 primigravida women who were in their third trimester from the selected antenatal clinics of Mangalore were selected for the study using purposive sampling technique. Demographic proforma and attidude scale was used for data collection. The results revealed that majority (50.5%) of women had neutral attitude regarding caesarean section, (41.5%) had favourable attitude and (8%) had unfavourable attitude towards caesarean section. Majority (71.5%) of women had favourable attitude regarding vaginal delivery, (20%) had neutral attitude and (8.5%) had unfavourable attitude towards vaginal delivery. And also there was a significant association of attitude with source of information χ2 = 28.36 at P

For this study, the knowledge and utilization of Intermittent Preventive Treatment (IPT) for malaria control among pregnant women attending antenatal clinics in the Primary Health Care Centers in the Sunyani West District of Ghana was assessed. A cross-sectional descriptive survey was conducted to assess antenatal accessibility and practices of IPT, knowledge of pregnant women on IPT use, and the effectiveness of IPT towards the reduction of malaria in pregnancy. The researcher used both secondary and primary data to elicit information for the study. The tools for the primary data collection were structured questionnaire and focused group discussion. Data was collected in two health facilities in the Sunyani West. Data was analyzed using Statistical Package for Social Science (SPSS) version 20.0 and the results were presented using frequencies, graph, cross tabulation and level of association using Chi-square. The study shows that the knowledge and utilization of IPT among pregnant women in Sunyani West District were very low. Majority of the respondents (68.2%) did not have knowledge on ITP use. Thus at 95% confidence level, the proportion of those who did not have knowledge on IPT use and those who had was highly significant (p1≠P2). The major challenges that were identified to suppress the effectiveness of IPT utilization from the health care provider point of view included inadequate Antenatal Clinic trained staff, low facility coverage and late ANC reporting of pregnant women. This study, therefore, recommends that healthcare providers in the district should intensify education on the use of Intermittent Preventive Treatment of malaria in pregnant women through community durbars, and radio and Television programs.

This paper presents results from an analysis of patients’ records of 711 pregnant women (14-40 year olds) between June 2002 and March 2012 and is a retrospective study. The study investigated anthropometric characteristics and mean arterial pressure in preeclamptic and normotensive pregnant women visiting antenatal clinics in South Africa’s Mthatha area. BMI, WHR and MAP in Black African women in this area were carried out in order to fill a gap as data of association or correlation of such data on this population could not be located. The Research questions were: (a) Are MAP, BMI and WHR higher in preeclamptic women than in normotensive pregnant women in South Africa’s Mthatha area? and, (b) Which one of the parameters (BMI, WHR and MAP) can be used as a strong predictor of occurrences of preeclampsia in this area? The data were statistically analysed. The main conclusions were that there were higher MAP, BMI and WHR in preeclamptic women than those who were not. Also, the study found a high correlation of these parameters in preeclamptic women. BMI correlated with DBP, MAP and WHR (r=0.43, r=0.38, r=0.44, respectively), whereas WHR correlated with BMI and DBP only (r=0.44, 0.40, respectively). Therefore, MAP, BMI and WHR may be used as predictors of preeclampsia. Between the three, BMI correlated more with both DBP and MAP. Therefore, BMI may be a better predictor than WHR. Similar to other studies, we also found that age was a risk factor for preeclampsia and that waist circumference was higher in preeclamptic women. DOI: 10.5901/mjss.2014.v5n20p2075

Objective The UK Government has prioritised shared decision making (SDM) and choice in maternity services, but no studies have explored the breadth of antenatal decisions or the feasibility of this aspiration. This study aimed to describe the decisions made, investigate the factors associated with choice and explore SDM practice. Methods Cross-sectional audio-recording of consultations in a UK district general hospital. Multi-level regression models were used to investigate associations between choice and doctor, patient, consultation and decision variables. Results 585 decisions were documented with a mean of 3.0 (SD 1.5) per consultation. No choice was offered in 75% of decisions. Choice was associated with the decision topic, consultation length, Royal College membership status and presence on the specialist register. Conclusions Without a choice, it will be challenging for a patient and their healthcare profession to truly share decisions. Practice Implications If universal SDM is the aim, then further work is required to understand the factors impacting choice availability and SDM, while engaging and supporting healthcare professionals to offer options and share decisions with patients.

1. Van der Bij A.K., Pitout J.D. The role of international travel in the worldwide spread of multiresistant Enterobacteriaceae. // J Antimicrob Chemother.2012.-No67.-P.2090-2100. 2. The European Committee on Antimicrobial Susceptibility Testing. Breakpoint tables for interpretation of MICs and zone diameters. Version 4.0, 2014. http://www.eucast.org 3. Pathak A1, Chandran SP, Mahadik K, Macaden R, Lundborg CS. Frequency and factors associated with carriage of multi-drug resistant commensal Escherichia coli among women attending antenatal clinics in central India. BMC Infect Dis. 2013 May 2;13:199. 13-199. 4. Walsh TR, Weeks J, Livermore DM, Toleman MA. Dissemination of NDM-1 positive bacteria in the New Delhi environment and its implications for human health: an environmental point prevalence study. Lancet Infect Dis. 2011 May;11(5):355-62. (11)70059-7. The problem of antibiotic resistance spreading has reached the global level requiring an immediate actions. One of the possible way to spread out such microorganism is migration, including traveling due to foreign education [1]. The aim of this study is to analyze the antibiotic resistance of microorganisms by Enterobacteriaceae family isolated from foreign medical students (India, Pakistan) and medical students of Kazakhstan studying at Karaganda State Medical University, Kazakhstan.

The National Institute for Health and Clinical Excellence (NICE, 2011) recommends that clinical care for women with multiple pregnancies should be provided by a specialist multidisciplinary team involving specialist midwives with experience and knowledge of managing multiple pregnancies. It highlights that current evidence, based on observational studies is of low quality. This systematic review has summarised all the available evidence on specialised antenatal care for women with a multiple pregnancy for improving maternal and infant outcomes (Dodd and Crowther, 2012).

This mixed-methods study explores factors associated with and levels of engagement of fathers in antenatal care. One hundred expectant fathers were recruited from antenatal clinics and community settings in Western Australia. They completed validated questionnaires. Eighty-three percent of expectant fathers reported a lack of engagement with antenatal care. Factors significantly associated with lack of engagement in multivariate analysis were working more than 40 hours a week and lack of adequate consultation by antenatal care staff. In qualitative analysis, 6 themes emerged in association with a lack of engagement. They were role in decision making, time pressures, the observer effect, lack of knowledge, barriers to attendance, and feeling unprepared or anxious. Care providers should involve fathers in consultations to improve paternal engagement.

The objective was to explore the meaning of the phenomenon of problem solving in midwifery when the midwife is faced with a critical situation in the absence of an obstetrician or any other physician. A qualitative method was used and critical incidents from delivery wards and/or antenatal clinics in the south of Sweden were narrated by midwives and transcribed verbatim. The interviews were then analysed using a phenomenological method. Seven midwives, all with at least five years working experience of both antenatal and delivery ward work participated. Problem solving in midwifery showed itself to be a multifaceted phenomenon. Some of the facets were to listen, to assess, to make fast decisions, to possess knowledge and experience, to use intuition, to be able to identify a problem and find a solution, cooperation, engagement, purposefulness, concentration, euphoria, consideration and control. Knowledge about the meaning of problem solving in midwifery can influence the working team to support the midwife to solve problems in critical situations. The knowledge is also useful in midwifery education.