Providing antenatal services in a primary health care system

For You and Your Baby (4YYB): Adapting the Centers for Disease Control and Prevention's Text4Baby Program for Saudi Arabia

BACKGROUND

Poor birth outcomes in the Kingdom of Saudi Arabia (KSA) have been found to be partially due to missed prenatal appointments as well as lack of knowledge of healthy pregnancy behaviors.

OBJECTIVE

The objectives are to summarize birth outcomes and the antenatal care system in KSA, summarize research related to the US Text4Baby mobile health program, and outline the development of an Arabic version of the Text4baby app, For You and Your Baby (4YYB).

METHODS

First, birth outcomes, health care access, and smartphone usage among Saudi Arabian women are reviewed. Next, the current evidence behind Text4Baby is described. Finally, a plan to develop and test 4YYB is proposed. In the plan, studies will need to be conducted to determine the effectiveness of 4YYB in educating pregnant Saudi women on healthy knowledge and behaviors. This will create an evidence base behind 4YYB before it is launched as a full-scale public health effort in KSA.

RESULTS

The KSA offers public medical services but remaining challenges include poor birth outcomes and health care access barriers. An estimated 73% to 84% of Saudi women of child-bearing age use smartphone social media apps. A total of 13 published articles on Text4Baby were identified and reviewed. Due to design limitations, the studies provide only limited evidence about the effectiveness of the program in increasing healthy pregnancy knowledge and behaviors. To be useful for Saudi women, the educational messages in 4YYB will need to be translated from English to Arabic and tailored for cultural norms.

CONCLUSIONS

Developing the 4YYB Arabic-language app for use by pregnant Saudi Arabian women based on Text4Baby is a viable approach, but a rigorous study design is needed to determine its effectiveness in improving healthy pregnancy knowledge and behaviors.

Maternal perceptions of antenatal care provision at a tertiary level hospital, riyadh

OBJECTIVE

Report maternal perceptions of antenatal care provision and identify deficiencies in the current model of care provision.

METHODS

A survey was conducted to record maternal views about quality of antenatal consultations provided at a tertiary level hospital. Trained nurses and female health workers interviewed the patients attending antenatal visits during the month of July 2009. A standard questionnaire was use to enter the responses. Data were entered into the statistical package for social sciences (SPSS) for appropriate statistical analysis of the results. Data analysis generated two groups. One group had up to 4 antenatal visits and the other group had more than 4 visits.

RESULTS

Responses were obtained for 244 patients. Chi-square test was applied for the comparison of variables between the two groups. Significantly higher number of women preferred to follow the 4 visit care plan (n=118/244 vs. n=103/244, respectively; p=0.004). Patient satisfaction was also significantly higher among women in the 4 visit group (n=112/244 vs. n=90/244; p=0.04). More than 50% of patients said that they did not receive any information about the process of labor, breast-feeding or contraception.

CONCLUSION

Women included in the study did not want frequent visits to antenatal clinic. Efforts should be made to provide information about labor, breast-feeding and contraception.

Womens' opinions on antenatal care in developing countries: results of a study in Cuba, Thailand, Saudi Arabia and Argentina

BACKGROUND

The results of a qualitative study carried out in four developing countries (Cuba, Thailand, Saudi Arabia and Argentina) are presented. The study was conducted in the context of a randomised controlled trial to test the benefits of a new antenatal care protocol that reduced the number of visits to the doctor, rationalised the application of technology, and improved the provision of information to women in relation to the traditional protocol applied in each country.

METHODS

Through focus groups discussions we were able to assess the concepts and expectations underlying women's evaluation of concepts and experiences of the care received in antenatal care clinics. 164 women participated in 24 focus groups discussion in all countries.

RESULTS

Three areas are particularly addressed in this paper: a) concepts about pregnancy and health care, b) experience with health services and health providers, and c) opinions about the modified Antenatal Care (ANC) programme. In all three topics similarities were identified as well as particular opinions related to country specific social and cultural values. In general women have a positive view of the new ANC protocol, particularly regarding the information they receive. However, controversial issues emerged such as the reduction in the number of visits, particularly in Cuba where women are used to have 18 ANC visits in one pregnancy period.

CONCLUSION

Recommendations to improve ANC services performance are being proposed. Any country interested in the application of a new ANC protocol should regard the opinion and acceptability of women towards changes.

[Criteria for choosing health care facilities for prenatal care in Pelotas, RS, Brazil]

OBJECTIVE

To describe the prenatal care delivered to a representative sample of mothers, identifying the health care facility they attended and to explore the reasons that led them to choose that specific health facility.

METHOD

A cross-sectional study was conducted at four maternity hospitals in Pelotas, in Southern Brazil, from March to April 1997. A total of 401 mothers were interviewed at the hospital, immediately after delivery.

RESULTS

The majority of mothers (51%) were followed up at a primary health care facility (PHCF). The main reported reason for choosing a PHCF was its geographic accessibility (46.8%). For 85% of the mothers, the nearest health service was a PHCF. However, 52.2% of them did not attend the consultations at this setting mainly because of a supposed low quality care (37.4%). Except for immunization with tetanus toxoids, all other usual prenatal care procedures recommended by the local health ministry, including promotion of breastfeeding, were performed less frequently at the PHCF than in other health care settings.

CONCLUSION

Given the high coverage of the public prenatal care program, efforts should be made to improve the quality of care delivered to pregnant women, mainly by encouraging health professionals, especially doctors, to follow the established guidelines.

Socio-demographic determinants of antenatal care

A large scale community-based study in South Kanara district of Karnataka state, India has revealed that, despite a low infant mortality rate (IMR), there is a clear association between IMR and lack of antenatal care (ANC) as well as IMR and poor quality ANC. We analyse the factors which determine the utilization of ANC and show the association between quality of ANC and maternal literacy, occupation, age and parity. Factors which are also significantly associated are socio-economic status, religion and matriarchal system. Characteristically, those who do not receive any ANC are poor, illiterate, multiparous unskilled mothers over 30 years of age and who live far away from a medical facility. This study conclusively demonstrates that even in regions where IMR is low there is enough scope to reduce it further by concentrating our efforts on the high risk population.