Independent and joint contributions of inadequate antenatal care timing, contacts and content to adverse pregnancy outcomes

Evolution and determinants of antenatal care services utilization among women of reproductive age in Rwanda: a scoping review

BACKGROUND

Maternal and child health remains a global priority, with antenatal care (ANC) recognized as essential for ensuring positive pregnancy outcomes. Despite significant improvements, in low- and middle-income countries, ANC service utilization remains low in Sub-Saharan Africa. This paper contributes to the understanding of the evolution and determinants of ANC service utilization among women of reproductive age in Rwanda.

METHODS

This review focused on studies published between 2010 and 2024 and examined the factors associated with ANC utilization in Rwanda. Two reviewers independently performed screening of the abstracts and full texts and conducted data extraction and synthesis. The aggregated odds ratios for various factors associated with ANC service utilization were presented in forest plots, created using GraphPad Prism version 10.

RESULTS

The review included 11 studies and 1 report on ANC service utilization in Rwanda. By 2019-2020, 47% of women had received ANC in the first trimester, and 59% had four or more visits. Higher education levels, better wealth status, health insurance coverage, and small household size are associated with adequate ANC service utilization. Conversely, a significant distance from health facilities and unwanted pregnancies were associated with lower odds of adequate ANC utilization. Delayed ANC was more likely among women with higher parity, those who lacked social support, and those with no or only primary education.

CONCLUSION

Rwanda has made considerable strides in improving ANC services. Addressing barriers such as distance to healthcare facilities, education, and economic disparities is crucial for enhancing maternal and child health outcomes. This review underscores the need for targeted interventions to achieve the World Health Organization recommendations of 8 antenatal care visits and sustainable development goals related to maternal and child health in Rwanda.

Association between quality of antenatal care service utilisation and adverse birth outcomes among adolescent women in 22 Sub-Saharan African countries. A mixed-effects multilevel analysis

OBJECTIVES

This study aimed to assess the association between the quality of antenatal care (ANC) service utilisation and adverse birth outcomes among adolescent women in Sub-Saharan Africa (SSA).

METHODS

A two-level mixed-effects model was employed using the recent Demographic Health Survey (DHS) data from 22 SSA countries. Both bivariable and multivariable multilevel analyses were conducted to assess the association between individual and community level factors with adverse birth outcomes. The results of the fixed effects model were interpreted in the form of adjusted odds ratios (AORs) with 95% confidence intervals (95% CIs).

RESULTS

In SSA, 23.5 % of adolescent mothers experienced adverse birth outcomes. This study found that receiving high quality ANC was associated with a 28 % reduction in the likelihood of adverse birth outcomes (AOR = 0.72, 95 % CI: 0.63, 0.83). Among the individual-level factors, middle-aged adolescence (AOR = 1.23, 95 % CI: 1.11, 1.36), being a female newborn (AOR = 1.15, 95 % CI: 1.05, 1.26), single marital status (AOR = 0.87, 95 % CI: 0.78, 0.96) and higher educational status (AOR = 0.83, 95 % CI: 0.74, 0.93) were significantly associated with adverse birth outcomes. From the community-level variables, women from Eastern Africa had positive significant association with adverse birth outcomes (AOR = 1.30, 95 % CI: 1.15, 1.46).

CONCLUSIONS

Nearly one-fourth of adolescent women in SSA experienced at least one type of adverse birth outcome. Low quality of ANC was significantly associated with adverse birth outcomes. Policymakers need to consider a comprehensive, essential, and minimal package of ANC to enhance the quality of ANC, which is crucial for better adolescent birth outcomes.

Spatial patterns and predictors of missing key contents of care during prenatal visits in Ethiopia: Spatial and multilevel analyses

BACKGROUND

Quality Antenatal Care (ANC) is considered if pregnant women have access to essential services that align with the best evidence-based practice. Although several studies have been conducted on ANC uptake in Ethiopia, they have focused on the timing and number of visits and the level of complete uptake of care contents according to the WHO recommendation remains scarce. Hence, this study aimed to assess the magnitude of missing care content during ANC visits, its spatial variations, and individual- and community-level determinants in Ethiopia.

METHODS

The study was conducted using the 2016 Ethiopian Demographic and Health Survey and included a total weighted sample of 4,771 women who gave birth within five years before the survey. Spatial analysis was carried out using Arc-GIS version 10.7 and SaTScan version 9.6 statistical software. Spatial autocorrelation (Moran's I) was checked to determine the non-randomness of the spatial variation in the missing contents of care. Multilevel multivariable logistic regression analysis was performed using STATA version 16. The adjusted odds ratio (aOR) with its corresponding 95% CI was used as a measure of association.

RESULTS

The prevalence of missing full contents of ANC in Ethiopia was 88.2% (95% CI: 87.2, 89.0), with significant spatial variations observed across regions. Missing essential contents of care was higher among women who live in rural areas (aOR = 1.68, 95% CI: 1.47, 2.71), not completed formal education (aOR = 1.94, 95% CI:1.24, 3.02), late initiation of ANC (aOR = 3.05, 95% CI:1.59, 6.54), attended only one ANC (aOR = 4.13, 95% CI: 1.95, 8.74), and not having a mobile phone (aOR = 1.44, 95% CI: 1.07, 1.95).

CONCLUSION

The level of missing care content during prenatal visits was high in Ethiopia, with significant spatial variation across regions. Health systems and policymakers should promote early initiation and encourage multiple visits to provide optimal care to pregnant women. In addition, it is vital to focus on enhancing education and healthcare infrastructure in rural parts of the country.

Assessment of quality of antenatal care services and associated factors in Malawi: Insights from a nationwide household survey

INTRODUCTION

Provision of quality antenatal care (ANC) to pregnant women is essential for reducing maternal and newborn mortality. ANC provides an opportunity for early identification of conditions that increase the risk of adverse pregnancy outcomes. However, there is limited evidence regarding the quality of ANC received by women in Malawi. This study aimed to assess the quality of ANC and associated factors in Malawi.

MATERIALS AND METHODS

National representative data from the 2019-2020 Malawi Multiple Indicator Cluster Survey was used for this cross-sectional study. A total of 6,287 weighted sample of women aged 15 to 49 years who had a live birth and received ANC at least once within two years preceding the survey were included in the analysis. Descriptive statistics were used to estimate the magnitude of quality ANC and multivariable logistic regression was computed to identify associated factors.

RESULTS

Of the 6,287 women, only 12.6% (95% CI: 11.4-13.9) received quality ANC. The likelihood of receiving quality ANC was significantly higher among women who had four to seven ANC contacts (AOR = 2.10; 95% CI: 1.79-2.49), made at least eight ANC contacts (AOR  =  3.40; 95% CI: 1.90-6.09) and started ANC within the first trimester (AOR  =  1.30; 95% CI: 1.10-1.53). On the other hand, women who had only primary education (AOR = 0.62; 95% CI:0.48-0.82) and had five or more births (AOR  =  0.56; 95% CI: 0.40-0.78) were less likely to receive quality ANC.

CONCLUSION

The findings reveal that quality of ANC in Malawi is low. These findings suggest the need for targeted interventions aimed at improving access to and utilization of ANC services among women with lower education and higher parity. Strengthening efforts to promote early ANC initiation and increasing the number of ANC contacts could significantly enhance the quality of ANC received by women in Malawi.

Patient-physician communication on herbal medicine use during pregnancy: a systematic review and meta-analysis

INTRODUCTION

Lack of transparent communication between patients and physicians regarding the use of herbal medicine (HM) presents a major public health challenge, as inappropriate HM use poses health risks. Considering the widespread use of HM and the risk of adverse events, it is crucial for pregnant women to openly discuss their HM use with healthcare providers. Therefore, this systematic review and meta-analysis aims to estimate the pooled prevalence of pregnant women's HM use and disclosure to healthcare providers and to examine the relationship between HM disclosure and various maternal and child health (MCH) measures.

METHODS

A systematic search of five databases was conducted for cross-sectional studies on HM use during pregnancy published from 2000 to 2023. Data extraction followed a standardised approach, and Stata V.16.0 was used for data analysis. Also, Spearman's correlation coefficient was calculated to examine the association between use and disclosure of HM and various MCH indicators.

RESULTS

This review included 111 studies across 51 countries on the use of HM among pregnant women. Our findings showed that 34.4% of women used HM during pregnancy, driven by the perception that HM is presumably safer and more natural than conventional medical therapies. However, only 27.9% of the HM users disclosed their use to healthcare providers because they considered HM as harmless and were not prompted by the healthcare providers to discuss their self-care practices. Furthermore, a significant correlation was observed between HM disclosure and improved MCH outcomes.

CONCLUSION

Inadequate communication between pregnant women and physicians on HM use highlights a deficiency in the quality of care that may be associated with unfavourable maternal outcomes. Thus, physician engagement in effective and unbiased communication about HM during antenatal care, along with evidence-based guidance on HM use, can help mitigate the potential risks associated with inappropriate HM use.