The effect of antenatal care follow-up on neonatal health outcomes: a systematic review and meta-analysis

The Impact of Prenatal Care on the Prevention of Neonatal Outcomes: A Systematic Review and Meta-Analysis of Global Health Interventions

BACKGROUND/OBJECTIVES

Neonatal outcomes, including low birth weight, preterm birth, and neonatal mortality, pose significant global health challenges, particularly in low- and middle-income countries. Prenatal care has emerged as a critical intervention in mitigating these risks through medical, nutritional, and psychosocial support. This study aimed to systematically assess the effectiveness of prenatal care interventions in preventing neonatal outcomes across diverse settings.

METHODS

A systematic review and meta-analysis were conducted according to PRISMA guidelines, with the protocol registered in PROSPERO (CRD42024601066). Fourteen peer-reviewed studies were included following a comprehensive search across five major databases. Eligible studies reported quantitative neonatal outcomes associated with prenatal care interventions, including nutritional supplementation, mental health services, telehealth, and routine antenatal care. Random-effects models were used for meta-analysis, and the risk of bias was assessed using RoB 2 and the Newcastle-Ottawa Scale.

RESULTS

Nutritional interventions, especially folic acid and iron supplementation, significantly reduced neonatal mortality by up to 40% (RR = 0.60, 95% CI: 0.54-0.68). High-quality prenatal care was associated with a 41% reduction in neonatal mortality. Psychosocial support reduced the risk of low birth weight and preterm birth, while telehealth interventions lowered NICU admissions in low-risk populations (RR = 0.88, 95% CI: 0.75-1.03). Heterogeneity was substantial (I2 = 70%), and publication bias was suggested.

CONCLUSIONS

Comprehensive prenatal care, integrating medical, nutritional, and mental health interventions, significantly improves neonatal outcomes. The global implementation of accessible, high-quality prenatal services is essential, particularly in underserved populations, to reduce neonatal morbidity and mortality.

The effect of antenatal care on low birth weight and neonatal mortality: protocol for umbrella review of meta-analysis

BACKGROUND

The World Health Organization defines low birth weight as a birth weight of less than 2500 g, regardless of the gestational age. It is regarded as the most significant predictor of infant mortality overall, particularly for deaths that occur in the first few months of life. Among all the months of a person's existence, the neonatal period, the first month of life, has one of the highest death rates. The necessity for an umbrella review is highlighted by the lack of a comprehensive synthesis of collective meta-analytic evidence connecting antenatal care as a factor of low birth weight and newborn death. Thus, this umbrella review's main goal is to thoroughly synthesize the existing meta-analytic evidence, with a focus on assessing the relationship between antenatal care with low birth weight and neonatal mortality.

METHODS

All English-language meta-analyses of cohort, case-control, and cross-sectional studies that looked at the relationship between antenatal care with low birth weight and neonatal mortality will be included, regardless of the time and location of publication. To find pertinent literature for review, major medical electronic databases including Embase, CINAHL, Cochrane database, and PubMed will be used. Two reviewers will screen the eligible articles, extract data, and evaluate their quality independently. The reviewers will work together to reach a consensus on any disagreements. If there are still issues, a third reviewer will be consulted in order to fix them. The meta-umbrella R package will be used for all statistical analysis. The random-effects model and 95% prediction interval for the summary estimate will be used for both outcomes. Q and I2 test statistics will be calculated to determine the degree of heterogeneity. We will use Egger's regression asymmetry test to assess publication bias, the Ioannidis test for excess significance bias, and Hedges' g value for each risk factor.

DISCUSSION

This is the first comprehensive analysis of the effect of antenatal care on low birth weight and neonatal mortality that we are aware of. For clinicians and researchers seeking to lower low birth weight and neonatal mortality, summarizing this evidence is helpful.

TRIAL REGISTRATION

PROSPERO-CRD42024567150.

Risk of adverse obstetrical and neonatal outcomes in women consuming recreational drugs during pregnancy

BACKGROUND

Previously conducted studies have observed an increased risk of adverse maternal and neonatal outcomes with prenatal exposure to cocaine and opioids. However, these studies used drug-free reference groups which did not efficiently control for confounders associated with polysubstance use in pregnancy. Thus, we conducted an observational study to compare the risk of adverse obstetrical and neonatal outcomes in women who consumed cocaine and/or opioids during pregnancy to women who consumed only cannabis in pregnancy.

METHODS

This observational study was conducted with data collected from pregnant women followed for addiction from the beginning of their pregnancy until childbirth at the perinatal consultation center Addi-Vie at CHUV Lausanne, Switzerland. Women who reported consuming cocaine, opioids, or both along with or without cannabis were included in the exposed group, while women who reported use of only cannabis during pregnancy were included in the reference group. We assessed for two adverse composite outcomes namely: adverse obstetrical composite outcome (4 outcomes) and adverse neonatal composite outcome (7 outcomes). Weighted logistic regression with weights obtained through inverse probability treatment weighting was conducted. For this analysis, we reported a conditional odds ratio (ORconditional) and 95% confidence interval (CI).

RESULTS

We included 177 pregnant women in this study, with 80 included in the exposed group and 97 included in the reference group. In the exposed group, 81.2% of women reported the use of opioids, and 39.9% of women reported the use of cocaine during pregnancy. In this study, prenatal cocaine and/or opioid exposure was associated with reduced odds of adverse obstetrical composite outcomes (ORconditional: 0.39, 95% CI: 0.17-0.88) compared to prenatal cannabis use. We also observed that the pregnant women exposed to cocaine and/or opioids during pregnancy were at 3.88 (ORconditional: 3.88, 95% CI: 1.23-12.23) times higher odds of experiencing the adverse neonatal composite outcome compared to our reference group.

CONCLUSION

Prenatal use of cocaine and/or opioids during pregnancy is observed to increase the odds of adverse neonatal composite outcomes. Encouraging substance users to seek antenatal care in earlier stages of pregnancy and targeted treatment approaches through interprofessional collaboration could prevent such adverse outcomes in pregnancy.

What does it cost to deliver antenatal care in Papua New Guinea? Results from a health system costing and budget impact analysis using cross-sectional data

OBJECTIVE

In Papua New Guinea (PNG), antenatal clinic attendance averaged 50% for one or more visits, and 30% for four visits in the last decade. In 2016, the WHO revised its focused antenatal care (ANC) model recommending eight rather than four visits. If implemented, this new model would require additional resources. This study estimated provider costs of ANC in PNG, including the expected cost of scaling up to universal ANC coverage as well as recommending eight visits.

DESIGN AND SETTING

Cross-sectional estimation of ANC costs collected from nine health facilities, which were part of a cluster randomised trial. Costs were estimated using both top-down and bottom-up approaches. The cost of the first and follow-up visits were estimated per woman, at the health facility level. Health system and scale-up costs of four visits were calculated by multiplying the aggregate cost of four visits by ANC utilisation rates. A budget impact analysis estimated the expected costs of delivering eight visits over 5 years. Univariate sensitivity analysis was conducted. Discounted costs are reported in local currency and 2019 international dollars using purchasing power parity data.

RESULTS

The average cost of the first and follow-up visits were $17.66-$30.58 (K42.94-K74.34) in Madang and $11.26-$35.61 (K27.37-K86.56) in East New Britain. Four visits per woman cost $70.65-$122.33 (K171.76-K297.36) in Madang and $45.02-$142.45 (K109.50-K346.4) in East New Britain; and salaries represented the largest share of costs. The annual health system cost was $6.9 million (K16.9 million), the expected cost of scaling up to the universal coverage of four visits was $22.7 million (K55.2 million), and $45.4 million (K110.3 million) over 5 years for eight visits.

CONCLUSION

Costs varied with the number of clinicians, infrastructure and ANC coverage, suggesting scaling up requires increasing the financial investment in ANC services. These results provide a template to strengthen health systems by improving the quality of care.

Determinants of adequate antenatal care visits among pregnant women in low-resource setting: evidence from Tanzania national survey

BACKGROUND

Antenatal care (ANC) plays a crucial role in reducing maternal fatalities and morbidities through early detection and management of pregnancy-related complications and ensures the proper referral in the level of care. Various variables facilitate a pregnant woman's ability to schedule enough ANC visits. This research sought to identify factors contributing to Tanzanian pregnant women receiving adequate antenatal care.

METHODS

The study used data from the 2015-16 TDHS-MIS. We analysed a total of 6924 included in the analysis. The outcome variable was adequate ANC, and we assessed different predictors on how they influence good antenatal care attendance. Bivariate (chi-square) and multivariate logistic regression were conducted at the statistical significance of p < 0.05.

RESULTS

3438 (49.7%) had inadequate ANC visits. Determinants for antenatal attendance included giving birth outside health facility (aOR = 0.77, 95%CI = 0.62-0.95, p-value = 0.02) are less likely to complete all the ANC, mothers who book early for ANC (aOR = 5.79, 95%CI = 4.56-7.35, p-value < 0.001) were more likely to achieve the recommended visits, parity of 2 to 4 (aOR = 0.63, 95%CI = 0.48-0.81, p-value < 0.001), and five and above (aOR = 0.48, 95%CI = 0.35-0.68, p-value < 0.001) showed a decreased odd to complete adequate ANC, the use of the Internet (aOR = 1.62, 95%CI = 1.08-2.42, p-value = 0.02) were two times more likely to attend the required visits, pregnant mothers who experienced sexual violence from partners (aOR = 0.70, 95%CI = 0.52-0.94, p-value = 0.02) were less likely to complete the adequate visit, and the use of the mobile telephone for health-related issues (aOR = 1.476, 95%CI = 1.02-2.14, p-value = 0.04) slightly increase the chance of attending adequate visits.

CONCLUSION

This study identified determinants influencing ANC visits. ANC booking, using the Internet, and mobile phones enhance the likelihood of completing recommended ANC visits while higher parity and experiencing partner-related sexual violence decrease these chances. These findings show a need for addressing wealth inequality, geographical barriers, the impact of intimate partner violence, encouraging internet access for health information, and health promotion for early ANC booking to improve the uptake of ANC services.

Evaluating neonatal mortality in Malta compared with other EU countries: Exploring the influence of congenital anomalies and maternal risk factors

BACKGROUND

Globally, 240,000 babies die in the neonatal period annually due to congenital anomalies (CA). Malta reports the highest neonatal mortality rate (NMR) among EU (European Union) Countries, constituting a public health concern.

OBJECTIVES

This study describes the contribution of CA to NMR in Malta, investigating possible associations with known maternal risk factors of maternal age, nationality, and education. Additionally, it provides an update on the contribution of CA to neonatal deaths in Malta and other EU countries.

METHODS

Anonymous data for births and neonatal deaths were obtained for 2006-2020 from the National Obstetrics Information System (NOIS) in Malta. Regression analyses adjusting for maternal risk factors were run on this data to explore possible associations with NMR. NMRs published by EUROSTAT 2011-2020 were used to compare mortality by underlying cause of death (CA or non-CA causes) for Malta and other EU countries.

RESULTS

Between 2006 and 2020, 63,890 live births with 283 neonatal deaths were registered in Malta, (NMR 4.4 per 1000 live births). CA accounted for 39.6% of neonatal deaths. No time trends were observed in either total NMR, NMR attributed to CA or mortality due to non-CA causes. Adjusted variables revealed associations for women hailing from non-EU, low-income countries. Malta registered high NMRs compared to EU countries, most marked for deaths attributed to CA.

CONCLUSIONS

Between 2006 and 2020, Malta's NMR remained stable. Maternal Nationality, from non-EU low-income countries, was associated with higher neonatal mortality. The influx of such migrants may play a partial role in the high NMRs experienced. Malta's high NMR was primarily driven by early neonatal deaths, which included high proportions of deaths due to CA and is linked to the fact that termination of pregnancy is illegal in Malta.

The nexus between maternal antenatal care attendance, newborn postnatal care and neonatal mortality in India: a matched case-control study

INTRODUCTION

Our study examines the relationship between newborn postnatal care and neonatal mortality stratified by maternal antenatal care attendance under a matched case-control framework.

METHODS

Data from the fifth round of the National Family Health Survey was used. A total of 172,079 recent births to eligible women (15-49 years) in five years preceding the survey were included in the study. We used the conditional logistic regression model, a commonly used regression model to fit matched case-control data to examine the effects of newborn postnatal care on neonatal mortality. The mother's age at birth of the newborn, previous birth intervals, birth order of the newborn, and birthsize of the newborn were included as the matching variables.

RESULTS

Newborns receiving postnatal care within two days or more than two days of birth are less likely to die during the neonatal period. Preferences for newborn postnatal care were also observed to increase with more maternal antenatal care visits. Our study also found a lower risk of neonatal mortality among those newborns whose umbilical cord was examined within two days of birth, regardless of the number of maternal antenatal care visits. Similarly, the risk of newborn deaths was lower among babies whose body temperature was measured within two days of birth. The tendency to breastfeed their newborns within an hour after delivery was considerably higher among those births that occurred to mothers who had a higher number of maternal antenatal care visits. The risk of newborn deaths was also observed to be lower among those born in public or private healthcare facilities.

CONCLUSION

Considering the cohesive nature of the relationship between neonatal mortality and maternal and child healthcare utilisation, strategic planning and management of the existing policies and programmes related to accessibility, availability, and affordability of maternal and child healthcare services is needed to achieve goal 3.2 of the Sustainable Development Goals. Promoting cost-effective measures such as continuous monitoring of the baby's body temperature and umbilical cord care could also effectively help reduce neonatal mortality.

Inadequacy of antenatal care attendance and its determinants amongst pregnant women in Ethiopia based on the 2019 Mini-Ethiopian demographic health survey: secondary data analysis

BACKGROUND

Inadequacy of antenatal care (ANC) utilization is a prominent public health problem, causing poor pregnancy outcomes. In developing countries, including Ethiopia, having ANC coverage, many pregnant women do not achieve the first ANC visits in the first trimester and receive at least four ANC visits. Therefore, this study aimed to examine the magnitude and identify determinants of inadequacy of antenatal care attendance amongst pregnant women in Ethiopia.

METHODS

Inadequate ANC attendance was defined as combining starting ANC visits after the first trimester and having fewer than four visits together. The study used secondary data from the 2019 mini-demographic and health survey. A weighted sample of 3927 pregnant women was included in this study. Data management and further analysis were performed using STATA 14 software. A multivariable generalized estimating equation analysis was used to identify determinants associated with inadequacy of antenatal care attendance. The Adjusted odds ratio with a 95% confidence interval was used to identify significant variables for inadequate antenatal care visits.

RESULT

Overall, 78.5% of pregnant women did not attend adequate antenatal care visits during pregnancy. In multivariable generalized estimating equation analysis, women aged 25 to 34 years (AOR = 0.77, 95% CI: 0.61-0.95), being educated (AOR = 0.31; 95% CI: 0.22-0.45), and being wealthier index (AOR = 0.67, 95% CI: 0.51-0.88) were less likely to inadequate antenatal care attendance. Whereas being rural residents (AOR = 1.49; 95% CI:1.08-2.07), no television exposure (AOR = 1.51; 95% CI:1.1-2.06), having more family members in the household (AOR = 1.81; 95% CI: 1.11-2.95), and women from semi-peripheral region (AOR = 1.92; 95% CI: 1.42-2.59) were higher odds of being associated with inadequacy of antenatal care attendance.

CONCLUSIONS

The prevalence of Inadequate antenatal care attendance amongst pregnant women in Ethiopia is still High. The study identifies significant variables that could be positively and negatively associated with inadequate antenatal care visits. Health education interventions should target uneducated, poorer, and rural women to attend early antenatal care and use at least four antenatal care utilization for early detection of complications during pregnancy and delivery.

Trends and inequalities in antenatal care coverage in Benin (2006-2017): an application of World Health Organization's Health Equity Assessment Toolkit

INTRODUCTION

Between 2006 and 2017, antenatal care (ANC) coverage in Benin declined, potentially exacerbating inequalities and substantiating the need for health inequality monitoring. This study examines inequalities in ANC attendance in Benin, disaggregated by women's age, educational level, economic status, place of residence, region of residence, and the extent to which they have changed over time.

METHODS

Three rounds of the Benin Demographic and Health Surveys (2006, 2011-12, and 2017-18) were analyzed to examine inequalities in ANC coverage. An exploratory descriptive approach was adopted for the analysis. Simple [difference (D) and ratio (R)] and complex [population attributable risk (PAR) and population attributable fraction (PAF)] measures of inequalities were computed using the World Health Organization's Health Equity Assessment Toolkit (WHO's HEAT) online platform. The measures were computed separately for each of the three surveys, and their estimates were compared.

RESULTS

The findings revealed an 8.4% decline in at least four ANC visits between 2006 and 2017-18. The decline occurred irrespective of age, educational status, economic status, place of residence, and region. Region-related inequalities were the largest and increased slightly between 2006 (D = 54.6; R = 2.6; PAF = 47.8, PAR = 29.0) and 2017-18 (D = 55.8; R = 3.1; PAF = 57.2, PAR = 29.8). Education (2006: D = 31.3, R = 1.6, PAF = 40.5, PAR = 24.5; 2017-18: D = 25.2, R = 1.6, PAF = 34.9, PAR = 18.1) and rural-urban (2006: D = 16.8, R = 1.3, PAF = 17.8, PAR = 10.8; 2017-18: D = 11.2, R = 1.2, PAF = 13.1, PAR = 6.8) inequalities reduced while economic status inequalities did not improve (2006: D = 48, R = 2.2, PAF = 44.5, PAR = 26.9; 2017-18: D = 43.9, R = 2.4, PAF = 45.0, PAR = 23.4). Age inequalities were very minimal.

CONCLUSION

ANC inequalities remain deeply ingrained in Benin. Addressing their varying levels requires comprehensive strategies that encompass both supply-and demand-side interventions, focusing on reaching uneducated women in the poorest households and those residing in rural areas and Atacora.

Exploring the association between multidimensional poverty and antenatal care utilization in two provinces of Papua New Guinea: a cross-sectional study

BACKGROUND

Although global poverty rates have declined in the last decade, the fall in the Asia-Pacific region has been slow relative to the rest of the world. Poverty continues to be a major cause of poor maternal and newborn health, and a barrier to accessing timely antenatal care. Papua New Guinea has one of the highest poverty rates and some of the worst maternal and neonatal outcomes in the Asia-Pacific region. Few studies have investigated equity in antenatal care utilization in this setting. We explored equity in antenatal care utilization and the determinants of service utilization, which include a measure of multidimensional poverty in Papua New Guinea.

METHODS

To explore the association between poverty and antenatal care utilization this study uses data from a ten-cluster randomized controlled trial. The poverty headcount, average poverty gap, adjusted poverty headcount, and multidimensional poverty index of antenatal clinic attendees are derived using the Alkire-Foster method. The distribution of service utilization is explored using the multidimensional poverty index, followed by multivariate regression analyses to evaluate the determinants of service utilization.

RESULTS

The poverty headcount was 61.06%, the average poverty gap 47.71%, the adjusted poverty headcount 29.13% and the average multidimensional poverty index was 0.363. Further, antenatal care utilization was regressive with respect to poverty. The regression analyses indicated that older women; being a widow (small number of widows (n = 3) asserts interpreting result with caution); or formally employed increase the likelihood of accessing antenatal care more often in pregnancy. Travelling for over an hour to receive care was negatively associated with utilization.

CONCLUSION

This study indicated high levels of multidimensional poverty in PNG and that ANC utilization was regressive; highlighting the need to encourage pregnant women, especially those who are economically more vulnerable to visit clinics regularly throughout pregnancy.

Incidence and predictors of acute kidney injury among asphyxiated neonates in comprehensive specialized hospitals, northwest Ethiopia, 2023

Acute kidney injury (AKI) is characterized by a sudden decline in the kidneys' abilities to remove waste products and maintain water and electrolyte homeostasis. This study aims to determine the incidence and predictors of acute kidney injury among neonates with perinatal asphyxia admitted at the neonatal intensive care unit of West Amhara Comprehensive Specialized Hospital, Northwest Ethiopia, 2023. Multicentred institution-based retrospective follow-up study was conducted from October 1, 2021, to September 30, 2023, among 421 perinatal asphyxia neonates. A simple random sampling technique was used. The data were collected using a data extraction checklist from the medical registry of neonates. The collected data were entered into EPI-DATA V.4.6.0.0. and analyzed using STATA V.14. The Kaplan-Meier failure curve and log-rank test were employed. Bivariable and multivariable Cox regression was carried out to identify predictors of Acute kidney injury. Statistical significance was declared at a p ≤ 0.05. The overall incidence of AKI was 54 (95% CI 47.07-62.51) per 100 neonate days. C/S delivery (AHR = 0.64; (95% CI 0.43-0.94), prolonged labor (AHR = 1.43; 95% CI 1.03-1.99) low-birth weight times (AHR = 1.49; (95% CI 1.01-2.20), stage three HIE(AHR: 1.68; (95% CI (1.02-2.77), No ANC follow up (AHR = 1.43; 95% CI 1.9 (1.07-3.43) and Hyperkalemia (AHR = 1.56; 95% CI 1.56 (1.05-2.29); 95% CI) were significant predictors. The incidence rate of acute kidney injury was higher than in other studies conducted on other groups of neonates. Cesarean section delivery, prolonged low birthweight, no Anc follow-up, stage 3 HIE, and neonatal hyperkalemia were predictors of acute kidney injury. However, it needs further prospective study. Therefore, the concerned stakeholders should give due attention and appropriate intervention to these predictors.

Association between achieving adequate antenatal care and health-seeking behaviors: A study of Demographic and Health Surveys in 47 low- and middle-income countries

BACKGROUND

Antenatal care (ANC) is essential for ensuring the well-being of pregnant women and their fetuses. This study models the association between achieving adequate ANC and various health and health-seeking indicators across wealth quintiles in low- and middle-income countries (LMICs).

METHODS AND FINDINGS

We analyzed data from 638,265 women across 47 LMICs using available Demographic and Health Surveys from 2010 to 2022. Via multilevel logistic regression analyses adjusted for a series of confounding variables and country and wealth quintile fixed effects, we estimated the projected impact of achieving adequate ANC utilization and quality on a series of health and health care indicators: facility birth, postnatal care, childhood immunizations, and childhood stunting and wasting. Achieving adequate levels of ANC utilization and quality (defined as at least 4 visits, blood pressure monitoring, and blood and urine testing) was positively associated with health-seeking behavior across the majority of countries. The strongest association was observed for facility birth, followed by postnatal care and child immunization. The strength of the associations varied across countries and wealth quintiles, with more significant ones observed in countries with lower baseline ANC utilization levels and among the lower wealth quintiles. The associations of ANC with childhood stunting and wasting were notably less statistically significant compared to other indicators. Despite rigorous adjustments for potential confounders, a limitation to the methodology is that it is possible that unobserved variables may still impact outcomes.

CONCLUSIONS

Strengthening ANC is associated with improved use of other health care in LMICs. ANC could serve as a critical platform for improving health outcomes for mothers and their children, emphasizing its importance beyond direct impact on maternal and neonatal mortality.

Predictors of neonatal near-misses in Worabe Comprehensive Specialized Hospital, Southern Ethiopia

Background

Neonatal deaths are still a major leading cause of social and economic crises. Identifying neonatal near-miss events and identifying their predictors is crucial to developing comprehensive and pertinent strategies to alleviate neonatal morbidity and death. However, neither neonatal near-miss events nor their predictors were analyzed in the study area. Therefore, this study is aimed at assessing the predictors of neonatal near-misses among neonates born at Worabe Comprehensive Specialized Hospital, Southern Ethiopia, in 2021.

Methods

A hospital-based unmatched case-control study was conducted from 10 November 2021 to 30 November 2021. A pre-tested, structured, and standard abstraction checklist was used to collect the data. After checking the data for completeness and consistency, it was coded and entered into Epi-Data 3.1 and then exported to Stata version 14 for analysis. All independent variables with a p-value ≤0.25 in bivariable binary logistic regression were entered into a multivariable analysis to control the confounding. Variables with p-values <0.05 were considered statistically significant.

Results

In this study, 134 neonatal near-miss cases and 268 controls were involved. The identified predictors of neonatal near-misses were rural residence [adjusted odds ratio (AOR): 2.01; 95% confidence interval (CI): 1.31-5.84], no antenatal care (ANC) follow-up visits (AOR: 2.98; 95% CI: 1.77-5.56), antepartum hemorrhage (AOR: 2.12; 95% CI: 1.18-4.07), premature rupture of the membrane (AOR: 2.55; 95% CI: 1.54-5.67), and non-vertex fetal presentation (AOR: 3.05; 95% CI: 1.93-5.42).

Conclusion

The current study identified rural residents, no ANC visits, antepartum hemorrhage, premature rupture of membrane, and non-vertex fetal presentation as being significantly associated with neonatal near-miss cases. As a result, local health planners and healthcare practitioners must collaborate in enhancing maternal healthcare services, focusing specifically on the early identification of issues and appropriate treatment.

Does health voucher intervention increase antenatal consultations and skilled birth attendances in Cameroon? Results from an interrupted time series analysis

BACKGROUND

Limited access to health services during the antenatal period and during childbirth, due to financial barriers, is an obstacle to reducing maternal and child mortality. To improve the use of health services in the three regions of Cameroon, which have the worst reproductive, maternal, neonatal, child and adolescent health indicators, a health voucher project aiming to reduce financial barriers has been progressively implemented since 2015 in these three regions. Our research aimed to assess the impact of the voucher scheme on first antenatal consultation (ANC) and skilled birth attendance (SBA).

METHODS

Routine aggregated data by month over the period January 2013 to May 2018 for each of the 33 and 37 health facilities included in the study sample were used to measure the effect of the voucher project on the first ANC and SBA, respectively. We estimated changes attributable to the intervention in terms of the levels of outcome indicators immediately after the start of the project and over time using an interrupted time series regression. A meta-analysis was used to obtain the overall estimates.

RESULTS

Overall, the voucher project contributed to an immediate and statistically significant increase, one month after the start of the project, in the monthly number of ANCs (by 26%) and the monthly number of SBAs (by 57%). Compared to the period before the start of the project, a statistically significant monthly increase was observed during the project implementation for SBAs but not for the first ANCs. The results at the level of health facilities (HFs) were mixed. Some HFs experienced an improvement, while others were faced with the status quo or a decrease.

CONCLUSIONS

Unlike SBAs, the voucher project in Cameroon had mixed results in improving first ANCs. These limited effects were likely the consequence of poor design and implementation challenges.

Inadequate weight gain and factors influencing it among preterm neonates in neonatal intensive care units in the Amhara region, Ethiopia, in 2022

Background

Adequate weight gain is crucial for the health and development of preterm neonates admitted to neonatal intensive care units (NICUs). Understanding the factors influencing weight gain in this vulnerable population is essential for improving outcomes. This study aimed to assess the weight gain status and associated factors among preterm neonates admitted to NICUs in specialized hospitals in the Amhara region of Ethiopia.

Methods

A cross-sectional study design involving 363 preterm neonates admitted to NICUs in specialized hospitals within the Amhara region was used. Data were collected using structured questionnaires and the Kobo Tool Box. Daily weight measurements were recorded for three consecutive days. Descriptive statistics, logistic regression analysis, and graphical presentations were utilized for data analysis and presentation.

Results

The study revealed that a significant proportion (80.8%) of preterm neonates experienced poor weight gain during their NICU stay. The factors significantly associated with poor weight gain were older maternal age, delayed initiation of enteral feeding, lack of kangaroo mother care (KMC), and inadequate antenatal care visits.

Conclusion

Addressing the identified factors, such as providing adequate support during the antenatal period, promoting a timely initiation of enteral feeding, and encouraging KMC practices, is crucial for improving weight gain outcomes in preterm neonates. The findings highlight the importance of a comprehensive approach to neonatal care targeting both maternal and neonatal factors. Policymakers and healthcare providers should prioritize interventions aimed at optimizing weight gain in preterm neonates to improve these neonates' overall well-being and long-term outcomes.

Effective coverage of antenatal care services in Ethiopia: a population-based cross-sectional study

BACKGROUND

Antenatal care (ANC) is a principal component of safe motherhood and reproductive health strategies across the continuum of care. Although the coverage of antenatal care visits has increased in Ethiopia, there needs to be more evidence of effective coverage of antenatal care. The 'effective coverage' concept can pinpoint where action is required to improve high-quality coverage in Ethiopia. Effective coverage indicates a health system's performance by incorporating need, utilization, and quality into a single measurement. The concept includes the number of contacts, facility readiness, interventions received, and components of services received. This study aimed to measure effective antenatal care coverage in Ethiopia.

METHODS

A two-stage cluster sampling method was used and included 2714 women aged 15-49 years and 462 health facilities from six Ethiopian regions from October 2019 to January 2020. The effective coverage cascade was analyzed among the targeted women by computing the proportion who received four or more antenatal care visits where the necessary inputs were available, received iron-folate supplementation and two doses of tetanus vaccination according to process quality components of antenatal care services.

RESULTS

Of all women, 40% (95%CI; 38, 43) had four or more visits, ranging from 3% in Afar to 74% in Addis Ababa. The overall mean health facility readiness score of the facilities serving these women was 70%, the vaccination and iron-folate supplementation coverage was 26%, and the ANC process quality was 64%. As reported by women, the least score was given to the quality component of discussing birth preparedness and complication readiness with providers. In the effective coverage cascade, the input-adjusted, intervention-adjusted, and quality-adjusted antenatal coverage estimates were 28%, 18%, and 12%, respectively.

CONCLUSION

The overall effective ANC coverage was low, primarily due to a considerable drop in the proportion of women who completed four or more ANC visits. Improving quality of services is crucial to increase ANC up take and completion of the recommended visits along with interventions increasing women's awareness.

Incidence and predictors of mortality among neonates admitted with birth asphyxia to neonatal intensive care unit of West Shewa Zone Public Hospitals, Central Ethiopia

BACKGROUND

Birth asphyxia is still one of the primary causes of newborn mortality worldwide. Similarly, the risk of newborn asphyxia in Ethiopia remains unacceptably high. Thus, studies on the incidence and predictors of mortality among newborns admitted with birth asphyxia are crucial to addressing this problem. As a result, the purpose of this study was to assess the incidence and predictors of mortality among neonates admitted with birth asphyxia to the neonatal intensive care units (NICUs) of West Shewa Zone Public Hospitals in Central Ethiopia.

METHODS

An institution-based retrospective cohort study was conducted among 760 asphyxiated neonates admitted to the NICUs of West Shewa Zone Public Hospitals between 30 March 2021 and 30 April 2023. The data were collected using CSEntry and analysed bu using Stata V.17. Bivariate and multivariate Cox proportional hazard regression analyses were carried out, and significant predictors were found using a 95% CI and a p<0.05.

RESULTS

A total of 760 asphyxiated neonates were followed for a total of 6880 neonatal days. At the end of follow-up, 263 (34.6%) of the neonates died (95% CI 31.3% to 38.1%), which resulted in a mortality incidence of 10.6/100 person-days of observation. Chewing khat (adjusted HR, AHR 2.21; 95% CI 1.13 to 4.31), home delivery (AHR 1.45, 95% CI 1.1 to 1.9), lack of antenatal care follow-up (AHR 1.44, 95% CI 1.08 to 1.89), hypothermia (AHR 1.56, 95% CI 1.12 to 2.17), hypoglycaemia (AHR 2.23, 95% CI 1.91 to 2.25) and obstructed labour (AHR 1.4, 95% CI 1.02 to 1.91) were found to be the significant predictors of neonatal mortality among asphyxiated neonates at a p≤0.05.

CONCLUSION AND RECOMMENDATION

The magnitude of neonatal mortality among asphyxiated neonates in the study area was high. Therefore, in order to significantly reduce the risks of birth asphyxia and subsequent newborn death, all interested stakeholders should take these predictors into consideration.

Delivery of a post-natal neonatal jaundice education intervention improves knowledge among mothers at Jinja Regional Referral Hospital in Uganda

BACKGROUND

Neonatal jaundice (NNJ) is a major contributor to childhood morbidity and mortality. As many infants are discharged by 24 hours of age, mothers are key in detecting severe forms of jaundice. Mothers with limited knowledge of NNJ have a hard time identifying these infants who could go on to have the worst outcomes. This study aimed to determine the effect of a jaundice education package delivered to mothers prior to hospital discharge on maternal knowledge after discharge.

METHODS

This was a before and after interventional study involving an education package delivered through a video message and informational voucher. At 10-14 days after discharge, participants were followed up via telephone to assess their post-intervention knowledge. A paired t-test was used to determine the effectiveness of the intervention on knowledge improvement. Linear regression was used to determine predictors of baseline knowledge and of change in knowledge score.

RESULTS

Of the 250 mothers recruited, 188 were fit for analysis. The mean knowledge score was 10.02 before and 14.61 after the intervention, a significant difference (p<0.001). Factors determining higher baseline knowledge included attendance of 4 or more antenatal visits (p < 0.001), having heard about NNJ previously (p < 0.001), having experienced an antepartum illness (p = 0.019) and higher maternal age (p = 0.015). Participants with poor baseline knowledge (β = 7.523) and moderate baseline knowledge (β = 3.114) had much more to gain from the intervention relative to those with high baseline knowledge (p < 0.001).

CONCLUSION

Maternal knowledge of jaundice can be increased using a simple educational intervention, especially in settings where the burden of detection often falls on the mother. Further study is needed to determine the impact of this intervention on care seeking and infant outcomes.

Prenatal care associated with neonatal outcomes in maternity hospitals: a hospital-based cross-sectional study

OBJECTIVE

To verify the association between prenatal care quality indicators and neonatal outcomes in maternity hospitals.

METHOD

Hospital-based cross-sectional study in four high-risk referral maternity hospitals in the five health macro-regions enabled by the Stork Network in Ceará-Brazil. Between April 2017 and July 2018, 440 puerperal women were interviewed using simple probabilistic sampling and a formula with finite populations and stratification of each maternity hospital. The analysis involved Pearson's Chi-Square, Adjusted Residuals Analysis and Fisher's Exact.

RESULTS

There was an association between fewer consultations with prematurity and low birth weight. Delivery in the maternity hospital where the woman lived was associated with low birth weight and the need for ventilatory support.

CONCLUSION

Prenatal care quality indicators influenced neonatal outcomes, which underlines the importance of ensuring access and quality of care as ways of reducing infant morbidity and mortality.

A cost-effectiveness analysis of a South African pregnancy support grant

Poverty among expectant mothers often results in sub-optimal maternal nutrition and inadequate antenatal care, with negative consequences on child health outcomes. South Africa has a child support grant that is available from birth to those in need. This study aims to determine whether a pregnancy support grant, administered through the extension of the child support grant, would be cost-effective compared to the existing child support grant alone. A cost-utility analysis was performed using a decision-tree model to predict the incremental costs (ZAR) and disability-adjusted life years (DALYs) averted by the pregnancy support grant over a 2-year time horizon. An ingredients-based approach to costing was completed from a governmental perspective. The primary outcome was the incremental cost-effectiveness ratio (ICER). Deterministic and probabilistic sensitivity analyses were performed. The intervention resulted in a cost saving of R13.8 billion ($930 million, 95% CI: ZAR3.91 billion - ZAR23.2 billion/ $1.57 billion - $264 million) and averted 59,000 DALYs (95% CI: -6,400-110,000), indicating that the intervention is highly cost-effective. The primary cost driver was low birthweight requiring neonatal intensive care, with a disaggregated incremental cost of R31,800 ($2,149) per pregnancy. Mortality contributed most significantly to the DALYs accrued in the comparator (0.68 DALYs). The intervention remained the dominant strategy in the sensitivity analyses. The pregnancy support grant is a highly cost-effective solution for supporting expecting mothers and ensuring healthy pregnancies. With its positive impact on child health outcomes, there is a clear imperative for government to implement this grant. By investing in this program, cost savings could be leveraged. The implementation of this grant should be given high priority in public health and social policies.

Contents of antenatal care services in Afghanistan: findings from the national health survey 2018

BACKGROUND

Maternal and newborn mortality is a public health concern in low- and middle-income countries (LMICs), including Afghanistan, where the evolving socio-political circumstances have added new complexities to healthcare service delivery. Birth outcomes for both pregnant women and their newborns are improved if women receive benefits of quality antenatal care (ANC).

OBJECTIVES

This study aimed to assess the contents of ANC services and identify predictors of utilization of services by pregnant women during ANC visits to health facilities in Afghanistan.

METHODS

In this cross-sectional study, we used data from the Afghanistan Health Survey 2018 (AHS2018). We included a total of 6,627 ever-married women, aged 14-49 years, who had given birth in the past 2 years or were pregnant at the time of survey and had consulted a health worker for ANC services in a health facility. The outcome was defined as 1-4 services and 5-8 services that a pregnant woman received during an ANC visit. The services were (i) taking a pregnant woman's blood pressure, (ii) weighing her, (iii) testing her blood, (iv) testing her urine, (v) providing advice on nutrition, (vi) advising about complicated pregnancy, (vii) advising about the availability of health services, and (viii) giving her at least one dose of Tetanus Toxoid (TT) vaccine. The binary outcome (1-4 services versus 5-8 services) was used in a multivariable logistic regression model.

RESULTS

Of all 6,627 women, 31.4% (2,083) received 5-8 services during ANC visits. Only 1.3% (86) received all 8 services, with 98.7% (6,541) receiving between 1 and 7 services, and 71.6% (4,745) women had their blood pressure measured during ANC visits. The likelihood (adOR = Adjusted Odds Ratio) of receiving 5-8 services was higher in women who could read and write (adOR = 1.33: 1.15-1.54), in women whose husbands could read and write (adOR = 1.14: 1.00-1.28), in primipara women (adOR = 1.42: 1.02-1.98), in women who knew one danger sign (adOR = 5.38: 4.50-6.45), those who knew 2 danger signs (adOR = 8.51: 7.12-10.19) and those who knew ≥ 3 danger signs (adOR = 13.19: 10.67-16.29) of complicated pregnancy, and in women who had almost daily access to TV (adOR = 1.16: 1.01-1.33). However, the likelihood of receiving 5-8 services was lower in women who used private clinics (adOR = 0.64: 0.55-0.74) and who received services from nurses (adOR = 0.27 (0.08-0.88).

CONCLUSION

Our findings have the potential to influence the design and implementation of ANC services of health interventions to improve the delivery of services to pregnant women during ANC visits.

Validation of maternal recall of number of antenatal care visits attended in rural Southern Nepal: a longitudinal cohort study

OBJECTIVES

This study aimed to examine the validity of maternal recall of total number of antenatal care (ANC) visits during pregnancy and factors associated with the accuracy of maternal recall.

DESIGN

This was a longitudinal cohort study conducted from December 2018 through November 2020.

SETTING

Five government health posts in the Sarlahi district of Southern Nepal.

PARTICIPANTS

402 pregnant women between ages 15 and 49 who presented for their first ANC visit at the study health posts.

MAIN OUTCOMES

The observed number of ANC visits (gold standard) and the reported number of ANC visits at the postpartum interview (maternal recall).

RESULTS

On average, women in the study who had a live birth attended 4.7 ANC visits. About 65% of them attended four or more ANC visits during pregnancy as recommended by the Nepal government, and 38.3% of maternal report matched the categorical ANC visits as observed by the gold standard. The individual validity was poor to moderate, with the highest area under the receiver operating characteristic curve (AUC) being 0.69 (95% CI: 0.65 to 0.74) in the 1-3 visits group. Population-level bias (as distinct from individual-level bias) was observed in the 1-3 visits and 4 visits groups, where 1-3 visits were under-reported (inflation factor (IF): 0.69) and 4 ANC visits were highly over-reported (IF: 2.12). The binary indicator ANC4+ (1-3 visits vs 4+ visits) showed better population-level validity (AUC: 0.69; IF: 1.17) compared with the categorical indicators (1-3 visits, 4 visits, 5-6 visits and more than 6 visits). Report accuracy was not associated with maternal characteristics but was related to ANC frequency. Women who attended more ANC visits were less likely to correctly report their total number of visits.

CONCLUSION

Maternal report of number of ANC visits during pregnancy may not be a valid indicator for measuring ANC coverage. Improvements are needed to measure the frequency of ANC visits.

Pre-Conceptional and Antenatal Care for Improved Newborn and Child Survival in India: A Review

There is sufficient scientific evidence that quality pre-conceptional care and antenatal care can improve newborn survival. This review was conducted to understand the concept of pre-conceptional care and its implementation status in India. The review documents the specific interventions that have been proven to effectively improve pregnancy outcome when provided as pre-conception care. Healthcare providers, particularly obstetricians/gynecologists and general physicians, should prioritize pre-conception care as an essential component of healthcare for women. However, the lack of continuum of care and program linkages are some of the key barriers in ensuring pre-conceptional and ante-natal care in India. Culturally and linguistically appropriate care should be provided to ensure that all women can access and understand the information and services needed to optimize their reproductive health and improve pregnancy outcomes. Prioritizing pre-conception and prenatal care, healthcare providers can improve maternal and fetal outcomes, reduce healthcare costs, and promote lifelong health for women and their families. The primary healthcare reforms being done in India can be and should be used to strengthen pre-conceptional and ante-natal care services and quality.

The Effectiveness of Adequate Antenatal Care in Reducing Adverse Perinatal Outcomes: Evidence From a Low- or Middle-Income Country

Background and aim Antenatal care (ANC) is universally acknowledged as an essential intervention for enhancing the well-being of both mothers and children. The World Health Organization advises a minimum of four ANC visits. The objective of this study is to assess the effectiveness of adequate ANC in mitigating adverse perinatal outcomes. Methods This cross-sectional study was done at the Department of Obstetrics and Gynecology, Delta Medical College & Hospital, Bangladesh, from March 2023 to August 2023. A total of 226 mothers who gave birth at the hospital during this period were enrolled in the study. Results More than 87% of the participants received adequate (≥4 visits) antenatal care from a registered physician. More than 84% of the mothers gave birth via cesarean section. Among the mothers who received inadequate ANC, the proportion of adverse perinatal outcomes was higher (69.0%) than that of those who received adequate ANC (32.0%). A significant association (p<0.05) was noted between inadequate antenatal care and adverse perinatal outcomes. Pregnant women receiving adequate antenatal checkups were 79% less likely to experience adverse perinatal outcomes compared to those receiving inadequate ANC. Conclusion Adequate ANC is a very efficient and economical strategy for mitigating adverse perinatal outcomes.

Factors determining antenatal care utilization among mothers of deceased perinates in Ethiopia

Introduction

Receiving adequate antenatal care (ANC) had an integral role in improving maternal and child health outcomes. However, several factors influence the utilization of ANC from the individual level up to the community level factors. Thus, this study aims to investigate factors that determine ANC service utilization among mothers of deceased perinate using the proper count regression model.

Method

Secondary data analysis was performed on perinatal death surveillance data. A total of 3,814 mothers of deceased perinates were included in this study. Hurdle Poisson regression with a random intercept at both count-and zero-part (MHPR.ERE) model was selected as a best-fitted model. The result of the model was presented in two ways, the first part of the count segment of the model was presented using the incidence rate ratio (IRR), while the zero parts of the model utilized the adjusted odds ratio (AOR).

Result

This study revealed that 33.0% of mothers of deceased perinates had four ANC visits. Being in advanced maternal age [IRR = 1.03; 95CI: (1.01-1.09)], attending primary level education [IRR = 1.08; 95 CI: (1.02-1.15)], having an advanced education (secondary and above) [IRR = 1.14; 95 CI: (1.07-1.21)] and being resident of a city administration [IRR = 1.17; 95 CI: (1.05-1.31)] were associated with a significantly higher frequency of ANC visits. On the other hand, women with secondary and above education [AOR = 0.37; 95CI: (0.26-0.53)] and women who live in urban areas [AOR = 0.42; 95 CI: (0.33-0.54)] were less likely to have unbooked ANC visit, while women who resided in pastoralist regions [AOR = 2.63; 95 CI: (1.02-6.81)] were more likely to have no ANC visit.

Conclusion

The uptake of ANC service among mothers having a deceased perinate was determined by both individual (maternal age and educational status) and community (residence and type of region) level factors. Thus, a concerted effort is needed to improve community awareness through various means of communication by targeting younger women. Furthermore, efforts should be intensified to narrow down inequalities observed in ANC service provision due to the residence of the mothers by availing necessary personnel and improving the accessibility of service in rural areas.

Diminution des mouvements actifs fœtaux: Profil épidémiologique et issue de la grossesse

INTRODUCTION

Decreased fetal movement is a common reason for consultation. It can reveal an intrauterine death or fetal distress.

AIM

To evaluate the epidemiological profile of decreased fetal movement and to identify the predictive factors of poor pregnancy outcome.

METHODS

We performed a retrospective and descriptive study in the department of Maternity between January 2015 and December 2019 including patients hospitalized for decreased fetal movements.

RESULTS

The study included 150 patients with a mean age of 30.7±5.8 years. The patients were primiparous in 45.3% of cases. The mean term of pregnancy was 37.17±2.97 weeks. Cardiotocography was pathological in 22.7% of patients. The delivery rate during the hospitalization was 87.3% with a mean term of 37.9±2.5 SA. Poor pregnancy outcome was noted in 22.1% of cases. The identified predictive factors of poor pregnancy outcome were: gestational term less than 37 weeks (ORa=9.42), insufficient prenatal care (ORa=2.85), delayed maternal reporting of decreased fetal movement (ORa=1.29), complications during pregnancy (ORa=3.01), small symphysiofundal height for gestational age (ORa=6.17), pathological cardiotocography (ORa=1.66), fetal growth restriction (ORa=6.17), abnormal Umbilical Artery Doppler (ORa=6.51).

CONCLUSION

Decreased fetal movement can be a false alarm but it is important to identify predictive factors of poor pregnancy outcome to recognize patients at increased risk and optimize their management.

Telehealth in antenatal care: recent insights and advances

BACKGROUND

For decades, antenatal care in high-resource settings has involved 12-14 face-to-face visits across pregnancy. The COVID-19 pandemic forced many care providers to rapidly embrace telehealth to reduce face-to-face visits. Here we review recent advances in telehealth used to provide antenatal care.

MAIN BODY

We conducted a narrative review examining the impact of telehealth on obstetric care. Two broad types of telehealth are used in antenatal care. The first is real-time telehealth, where consultations are done virtually instead of face-to-face. The second is remote monitoring, where in-clinic physical examinations are replaced with at-home alternatives. These can include blood pressure monitoring, fetal heart rate monitoring, and emerging technologies such as tele-ultrasound. Large cohort studies conducted during the pandemic era have shown that telehealth appears not to have increased adverse clinical outcomes for mothers or babies. However, further studies may be required to confidently conclude rare outcomes are unchanged, such as maternal mortality, serious morbidity, or stillbirth. Health economic studies suggest telehealth has the potential to reduce the financial cost of care provision. Telehealth in antenatal care seems to be acceptable to both pregnant women and healthcare providers.

CONCLUSION

Adoption of telehealth technologies may improve the antenatal care experience for women and reduce healthcare expenditure without adversely impacting health outcomes for the mother or baby. More studies are warranted to confirm telehealth does not alter the risk of rare outcomes such as maternal or neonatal mortality.

Predicting maternal healthcare seeking behaviour in Afghanistan: exploring sociodemographic factors and women's knowledge of severity of illness

BACKGROUND

Little is known whether women's knowledge of perceived severity of illness and sociodemographic characteristics of women influence healthcare seeking behavior for maternal health services in Afghanistan. The aim of this study was to address this knowledge gap.

METHODS

Data were used from the Afghanistan Health Survey 2018. Women's knowledge in terms of danger signs or symptoms during pregnancy was assessed. The signs or symptoms were bleeding, swelling of the body, headache, fever, or any other danger sign or symptom (e.g., high blood pressure). A categorical variable of knowledge score was created. The outcome variables were defined as ≥ 4 ANC vs. 0-3 ANC; ≥ 4 PNC vs. 0-3 PNC visits; institutional vs. non-institutional deliveries. A multivariable generalized linear model (GLM) was used.

RESULTS

Data were used from 9,190 ever-married women, aged 13-49 years, who gave birth in the past two years. It was found that 56%, 22% and 2% of women sought healthcare for institutional delivery, ≥ 4 ANC, ≥ 4 PNC visits, respectively, and that women's knowledge is a strong predictor of healthcare seeking [odds ratio (OR)1.77(1.54-2.05), 2.28(1.99-2.61), and 2.78 (2.34-3.32) on knowledge of 1, 2, and 3-5 signs or symptoms, respectively, in women with ≥ 4 ANC visits when compared with women who knew none of the signs or symptoms. In women with ≥ 4 PNC visits, it was 1.80(1.12-2.90), 2.22(1.42-3.48), and 3.33(2.00-5.54), respectively. In women with institutional deliveries, it was 1.49(1.32-1.68), 2.02(1.78-2.28), and 2.34(1.95-2.79), respectively. Other strong predictors were women's education level, multiparity, residential areas (urban vs. rural), socioeconomic status, access to mass media (radio, TV, the internet), access of women to health workers for birth, and decision-making for women where to deliver. However, age of women was not a strong predictor.

CONCLUSION

Our findings suggest that pregnant women's healthcare seeking behaviour is influenced by women's knowledge of danger signs and symptoms during pregnancy, women's education, socioeconomic status, access to media, husband's, in-laws' and relatives' decisions, residential area, multiparity, and access to health workers. The findings have implications for promoting safe motherhood and childbirth practices through improving women's knowledge, education, and social status.

Spatial distribution, and predictors of late initiation of first antenatal care visit in Ethiopia: Spatial and multilevel analysis

BACKGROUND

Despite the proven benefit of early initiation of first antenatal care visits as a means to achieve good maternal and neonatal health outcomes through early detection and prevention of risks during pregnancy, shreds of evidence showed that most of the women in Ethiopia start their ANC visits lately.

OBJECTIVE

To determine the spatial distribution and predictors of late initiation of first antenatal care visits among reproductive-age women in Ethiopia.

METHOD

The 2019 Ethiopian Mini Demographic and Health Survey (EMDHS) data were used. A total weighted sample of 2,935 reproductive-age women who gave birth in the five years preceding the survey and who had antenatal care visits for their last child was included. To check the nature of the distribution of late initiation of ANC visits, the global Moran's I statistics were applied. Gettis-OrdGi statistics and spatial interpolation using the Ordinary Kriging method were done to identify the spatial locations and to predict unknown locations of late initiation of first ANC visits, respectively. For the predictors, a multilevel mixed-effect logistic regression model was applied. Finally, statistical significance was declared at a p-value < 0.05.

RESULTS

The prevalence of late initiation of first ANC visits in Ethiopia was 62.6%. The spatial analysis showed that the late initiation of first ANC visits significantly varied across regions of Ethiopia. The spatial interpolation predicted the highest rates of late initiation of first ANC visits in the eastern SNNPRs, southern and western Oromia, and some parts of the Somalia region. Being rural residents, attending higher education, having medium wealth status, richer wealth status, richest wealth status, having ≥ 5 family size, a household headed by male, living in SNNPRs, and Oromia regions were significant predictors of late initiation of first ANC visits.

CONCLUSION

A clustered pattern of areas with high rates of late initiation of the first ANC visit was detected in Ethiopia. Public health intervention targeting the identified hotspot areas, and women's empowerment would decrease the late start of the first ANC visit. Furthermore, the identified predictors should be underscored when designing new policies and strategies.

Prevalence and Associated Factors of Client Satisfaction with Antenatal Care Services Among Antenatal Care Attendants in Ethiopia: A Systematic Review and Meta-Analysis

Background and Objective

An important indicator of the quality of antenatal care (ANC) is the satisfaction of the client. Despite this, women in Ethiopia are very dissatisfied with the quality of their ANC. In Ethiopia, a systematic review was conducted to estimate the pooled prevalence of client satisfaction (CS) with ANC services.

Methods

Only articles published in English were included in this review. Medline/PubMed, Web of Science, Google Scholar, Scopus, Ethiopian University Repository Online, and the Cochrane Library are the main databases. The review included cross-sectional studies written in English that met the inclusion requirements. Using a random effects model, the overall rate of CS with prenatal care was calculated. Additionally, Egger's test and funnel plots were used to examine publication bias. STATA version 14 was used to perform all statistical analyses.

Results

This review included 20 studies involving 8447 women attending prenatal care services. In Ethiopia, the overall customer satisfaction rate with prenatal care services was 60.42% (95% CI [51.33.99, 69.51]; I2 = 98.9%, P < 0.001). Previous ANC follow-up, iron and folic acid supplementation, and the last planned pregnancy were statistically associated with CS.

Conclusion and Global Health Implications

In Ethiopia, 60% of women are satisfied with their ANC. This shows that 40% of women are dissatisfied with the prenatal care provided by healthcare professionals. This will lead to a low utilization of ANC services throughout the country. Therefore, the Ethiopian government, especially the Ministry of Health and nongovernmental organizations (NGOs), must take measures to address this severity and improve identified factors.

Antenatal and postnatal factors associated with neonatal death in the Indian subcontinent: a multilevel analysis

OBJECTIVES

This study aimed to identify significant antenatal and postnatal factors associated with neonatal death at 2-7 days and at 2-28 days in the Indian subcontinent. Results from this study may help guide strategies to improve antenatal and postnatal care services and reduce neonatal mortality.

STUDY DESIGN

Nationally representative recent Demographic and Health Survey data sets from five countries, including Bangladesh, India, Pakistan, Maldives and Nepal, were used.

METHODS

Survey-weighted univariate distributions were used for study population characteristics and bivariate distributions, along with the chi-squared test for unadjusted associations. Finally, multilevel logistic regression models were performed to determine the association of antenatal care (ANC) and postnatal care (PNC) factors with neonatal deaths.

RESULTS

Among 200,499 live births, the highest neonatal death rate was observed in Pakistan, followed by Bangladesh, whereas the lowest rate was in Nepal. After adjusting for sociodemographic and maternal control variables, the multilevel analysis showed a significantly lower likelihood of neonatal death at 2-7 days and 2-28 days with ANC visits <12 weeks' gestation, at least four ANC visits during pregnancy, PNC visits within the first week after birth and breastfeeding. Delivery at home by a skilled birth attendant compared to unskilled birth attendant was significantly associated with lower neonatal death at 2-7 days. Multifoetal gestation was significantly associated with higher neonatal death at 2-7 days and at 2-28 days.

CONCLUSIONS

The findings suggest that strengthening ANC and PNC services will improve newborn health in the Indian subcontinent and decrease neonatal mortality.

Investigating Health Inequality Using Trend, Decomposition and Spatial Analyses: A Study of Maternal Health Service Use in Nepal

Objectives: (a) To quantify the level and changes in socioeconomic inequality in the utilization of antenatal care (ANC), institutional delivery (ID) and postnatal care (PNC) in Nepal over a 20-year period; (b) identify key drivers of inequality using decomposition analysis; and (c) identify geographical clusters with low service utilization to inform policy. Methods: Data from the most recent five waves of the Demographic Health Survey were used. All outcomes were defined as binary variables: ANC (=1 if ≥4 visits), ID (=1 if place of delivery was a public or private healthcare facility), and PNC (=1 if ≥1 visits). Indices of inequality were computed at national and provincial-level. Inequality was decomposed into explanatory components using Fairile decomposition. Spatial maps identified clusters of low service utilization. Results: During 1996-2016, socioeconomic inequality in ANC and ID reduced by 10 and 23 percentage points, respectively. For PND, the gap remained unchanged at 40 percentage points. Parity, maternal education, and travel time to health facility were the key drivers of inequality. Clusters of low utilization were displayed on spatial maps, alongside deprivation and travel time to health facility. Conclusion: Inequalities in the utilization of ANC, ID and PNC are significant and persistent. Interventions targeting maternal education and distance to health facilities can significantly reduce the gap.

Associations between primary healthcare and infant health outcomes: a cohort analysis of low-income mothers in Rio de Janeiro, Brazil

Background

Expanding primary healthcare to urban poor populations is a priority in many low-and middle-income countries and is essential to achieve universal health coverage (UHC). Between 2008 and 2016 the city of Rio de Janeiro undertook an ambitious programme to rapidly expand primary care to low-income areas through the family health strategy (FHS). Infant health impacts of this roll out are unknown. This study examines associations between maternal FHS utilisation and birth outcomes, neonatal and infant mortality.

Methods

A cohort of 75,339 live births (January 2009-December 2014) to low-income mothers in Rio de Janeiro was linked to primary care, birth, hospital and death records. The relationship between maternal FHS use and infant health outcomes was assessed through logistic regression with inverse probability treatment weighting and regression adjustment. Socioeconomic inequalities in the associations between FHS use and outcomes were explored through interactions. Primary outcomes were neonatal and infant death. Thirteen secondary outcomes were also examined to explore other important health outcomes and potential mechanisms.

Results

A total of 9002 (12.0%) infants were born to mothers in the cohort who used FHS services either before pregnancy or in the first two trimesters. There was a total of 527 neonatal and 893 infant deaths. Maternal FHS usage during the first two trimesters was associated with substantial reductions in neonatal [adjusted odds ratio (aOR): 0.527, 95% confidence interval (95% CI): 0.345; 0.806] and infant mortality (aOR: 0.672, 95% CI: 0.48; 0.924). Infants born to lower-income mothers and those without formal employment had larger reductions in neonatal and infant mortality associated with FHS use. Maternal FHS in the first two trimesters use was also associated with more antenatal care consultations and a lower risk of low birth weight and preterm birth.

Interpretation

Expanding primary care to low-income populations in Rio de Janeiro was associated with improved infant health and health equity benefits.

Funding

DFID/MRC/Wellcome Trust/ESRC.

Association between unintended pregnancy and maternal antenatal care services use in Ethiopia: analysis of Ethiopian demographic and health survey 2016

Introduction

Unintended pregnancy disproportionately affects women in low and middle-income countries including Ethiopia. Previous studies identified the magnitude and negative health outcomes of unintended pregnancy. However, studies that examined the relationship between antenatal care (ANC) utilization and unintended pregnancy are scarce.

Objective

This study aimed to examine the relationship between unintended pregnancy and ANC utilization in Ethiopia.

Methods

This is a cross-sectional study conducted using the fourth and most recent Ethiopian Demographic Health Survey (EDHS) data. The study comprised a weighted sample of 7,271 women with last alive birth and responded to questions on unintended pregnancy and ANC use. The association between unintended pregnancy and ANC uptake was determined using multilevel logistic regression models adjusted for possible confounders. Finally p < 5% was considered significant.

Results

Unintended pregnancy accounted for nearly a quarter of all pregnancies (26.5%). After adjusting for confounders, a 33% (AOR: 0.67; 95% CI, 0.57-0.79) lower odds of at least one ANC uptake and a 17% (AOR: 0.83; 95% CI, 0.70-0.99) lower odds of early ANC booking were found among women who had unintended pregnancy compared to women with intended pregnancy. However, this study founds no association (AOR: 0.88; 95% CI, 0.74, 1.04) between unintended pregnancy and four or more ANC visits.

Conclusion

Our study found that having unintended pregnancy was associated with a 17 and 33% reduction in early initiation and use of ANC services, respectively. Policies and programs designed to intervene against barriers to early initiation and use of ANC should consider unintended pregnancy.

Determinants of early initiation of first antenatal care visit in Ethiopia based on the 2019 Ethiopia mini-demographic and health survey: A multilevel analysis

BACKGROUND

Early initiation of the first antenatal care visit provides a critical opportunity for health promotion, disease prevention, and curative care for women and their unborn fetuses. However, in developing countries, including Ethiopia, it is underutilized and most of the pregnant women didn't attend antenatal care visits during the first trimester (early). Therefore, the objective of this study was to estimate the prevalence of early initiation of antenatal care visits and its determinants among reproductive-age women in Ethiopia.

METHODS

A secondary data analysis was done based on the 2019 intermediate Ethiopian demographic health survey. The data were weighted by sampling weight for probability sampling and non-response to restore the representativeness of the data and have valid statistical estimates. Then, a total weighted sample of 2,935 women aged 15-49 years who gave birth in the five years preceding the survey and who had antenatal care visits for their last child was included. A multilevel mixed-effects logistic regression model was fitted to examine the determinants of early initiation of first antenatal care visits. Finally, statistical significance was declared at a p-value < 0.05.

RESULTS

In this study, the overall magnitude of early initiation of the first antenatal care visit was 37.4% (95%CI: 34.6-40.2%). Women who attend higher education (AOR = 2.26: 95%CI; 1.36-3.77), medium wealth status (AOR = 1.80: 95%CI; 1.17-2.76), richer wealth status (AOR = 1.86: 95%CI; 1.21, 2.85), richest wealth status (AOR = 2.34: 95%CI; 1.43-3.83), living in Harari region (AOR = 2.24: 95%CI; 1.16-4.30), and living at Dire-Dawa city (AOR = 2.24: 95%CI; 1.16-4.30) were higher odds of early initiation of first ANC visits. However, women who were rural resident (AOR = 0.70: 95%CI; 0.59-0.93), household headed by male (AOR = 0.87: 95%CI; 0.72, 0.97), having ≥ 5 family size (AOR = 0.71: 95%CI; 0.55-0.93), and living in SNNPRs (AOR = 0.44: 95%CI; 0.23-0.84) were lower odds of early initiation of first ANC visits.

CONCLUSION

The prevalence of early initiation of first antenatal care remains low in Ethiopia. Women's education, residence, wealth status, household head, having ≥ 5 family sizes, and region were determinants of early initiation of first antenatal care visits. Improving female education and women's empowerment through economic transitions with special attention given to rural and SNNPR regional state residents could maximize the early initiation of first antenatal care visits. Furthermore, to increase early antenatal care uptake, these determinants should be considered when designing new policies or updating policies and strategies on antenatal care uptake to help increase early attendance, which can help in the reduction of maternal and neonatal mortality and to achieve sustainable development goals 3 by 2030.

Factors that affect the utilisation of maternal healthcare in the Mchinji District of Malawi

BACKGROUND

It is widely accepted that maternal healthcare is vital for improving maternal and neonatal mortality rates. Furthermore, the continuum of care-the integrated delivery of antenatal, delivery and postnatal care-has been shown to be particularly important. Sub-Saharan Africa has the highest neonatal and maternal mortality rates in the world; significant improvements in the provision and utilisation of the continuum are urgently needed, therefore the barriers preventing access need to be better understood. This study aimed to identify key factors associated with the utilisation of maternal healthcare, in the Mchinji District of Malawi.

METHODS

4,244 pregnant women from the Mchinji District of Malawi were interviewed between March and December 2013. The overall utilisation of maternal healthcare was calculated by combining the use of antenatal, delivery and postnatal care into one variable-continuum of care. Univariate and multivariate logistic regressions were performed to determine the factors associated with utilisation of maternal healthcare.

RESULTS

Utilisation of maternal healthcare in the Mchinji District was inadequate; only 24% of women received the recommended package. Being further from a healthcare facility (OR = 0.2, 95%CI = 0.04-0.96), having at least one live child (OR = 0.87, 95%CI = 0.84-0.99), previous experience of miscarriage (OR = 0.64, 95%CI = 0.50-0.82) or abuse (OR = 0.81, 95%CI = 0.69-0.95) reduced utilisation, whereas being in the richest 20% (OR = 1.33 95%CI = 1.08-1.65), having a planned pregnancy (OR = 1.3, 95%CI = 1.11-1.51) or more control over decisions (OR = 1.09, 95%CI = 0.80-1.49) increased utilisation.

CONCLUSION

Seven groups of women were identified as having an increased risk of low utilisation of maternal healthcare; women living >5km from a healthcare facility, within the poorest socio-economic group, experiencing an unplanned pregnancy, with at least one live child, experience of a previous miscarriage, no control over their healthcare decisions or experience of abuse. Policy makers should pay extra attention to these high-risk groups when designing and delivering strategies to improve maternal healthcare utilisation.

Demographic, Clinical Profile and Outcomes of Neonates Admitted to Neonatal Intensive Care Unit of Dekemhare Hospital, Eritrea

BACKGROUND

Ninety-six percent of the world's 3 million neonatal deaths occur in developing countries where the majority of births occur outside health facility. The objective of this study was to evaluate the demographic, clinical profile and outcome of neonates admitted to Neonatal Intensive Care Unit of Dekemhare Hospital of Eritrea.

METHODS

The study was a retrospective register-based review of all neonates admitted from January 2018 to December 2021 to Dekemhare Hospital. Overall, 509 neonates were enrolled in this study. Data were collected from neonatal register book from January 5 to February 5, 2022 by general practitioners using a predesigned data collection tool. Data entry was done using CSpro 7.3 and analyzed through SPSS version 22. Results were presented in frequencies, percent and odds ratio. Univariable and multivariable analysis was done to measure the association between the variables.

RESULTS

Three quarter (75.6%) of the neonates had normal birth weight and 80.0% were term. Majority (75.4%) of the neonates was delivered vaginally and 92.7% were delivered at health facility. Neonatal infection (33.0%), birth asphyxia (20%) and prematurity (14.3%) were the top three primary causes of neonatal admission to the Neonatal Intensive Care Unit. Furthermore, 31% of neonatal deaths occurred during 24-72 hours of their life and the mortality rate was 16.3%. Multivariable analysis indicated that low birth weight (AOR: 7.28; 95%CI: 2.85-18.55) increased neonatal mortality. Whereas delivery at health facility (AOR: 0.17; 95%CI: 0.06-0.47), hospital stay 4-7 days (AOR: 0.06; 95% CI: 0.02-0.23) and above 8 days (AOR: 0.06; 95%CI: 0.02-0.23) were showing protective effect on neonatal mortality.

CONCLUSION

Congenital abnormality, prematurity and birth asphyxia had higher case fatality rate. And, low birth weight, delivery at health facility and hospital stay were found to be predictors of neonatal mortality. Training of health professionals on neonatal resuscitation, further improvement on the diagnostic setup, treatment tools, infrastructure and raising community awareness to deliver at health facility are crucial to decrease the neonatal mortality in Eritrea.

Determinants of recommended antenatal care visits among pregnant women in Ethiopia: a generalized linear mixed-effects modeling

BACKGROUND

Although antenatal care has the potential role to reduce maternal and child morbidity and mortality, utilization of a recommended number of antenatal care visits is still low in Ethiopia. Therefore, this study aimed to assess the determinants of recommended antenatal care visits in Ethiopia.

METHOD

Data from the 2019 mini-Ethiopian demographic and health survey (MEDHS) was used for this study. A total of 3916 women who gave birth 5 years preceding the MEDHS were included. A generalized linear mixed-effects (mixed-effects logistic regression) model was used to identify the determinants of recommended antenatal care service utilization. Finally, the adjusted odds ratio with a 95% confidence interval and random effects were reported.

RESULTS

In the generalized linear mixed-effects model, women with primary education (AOR = 1.55, 95%CI 1.22-2.01), secondary and above education (AOR = 5.12, 95%CI 2.80-8.16), women from the middle (AOR = 1.25, 95%CI 1.01-1.71) and rich wealth index (AOR = 1.54, 95%CI 1.12-2.25), women who were exposed to media (AOR = 1.23,95%CI 1.01-1.57) and who use contraception (AOR = 1.45 95%CI 1.25-2.03), had higher odds of recommended antenatal care service utilization.

CONCLUSION

In this study, factors like maternal educational status, media exposure, wealth index and history of contraceptive utilization were significantly associated with recommended ANC visits in Ethiopia. Therefore, encouraging women for contraceptive service utilization, consulting women to be exposed to media and improving women's wealth status will help to have recommended number of ANC visits by pregnant women in Ethiopia.

Prioritizing Health Care Strategies to Reduce Childhood Mortality

IMPORTANCE

Although child mortality trends have decreased worldwide, deaths among children younger than 5 years of age remain high and disproportionately circumscribed to sub-Saharan Africa and Southern Asia. Tailored and innovative approaches are needed to increase access, coverage, and quality of child health care services to reduce mortality, but an understanding of health system deficiencies that may have the greatest impact on mortality among children younger than 5 years is lacking.

OBJECTIVE

To investigate which health care and public health improvements could have prevented the most stillbirths and deaths in children younger than 5 years using data from the Child Health and Mortality Prevention Surveillance (CHAMPS) network.

DESIGN, SETTING, AND PARTICIPANTS

This cross-sectional study used longitudinal, population-based, and mortality surveillance data collected by CHAMPS to understand preventable causes of death. Overall, 3390 eligible deaths across all 7 CHAMPS sites (Bangladesh, Ethiopia, Kenya, Mali, Mozambique, Sierra Leone, and South Africa) between December 9, 2016, and December 31, 2021 (1190 stillbirths, 1340 neonatal deaths, 860 infant and child deaths), were included. Deaths were investigated using minimally invasive tissue sampling (MITS), a postmortem approach using biopsy needles for sampling key organs and fluids.

MAIN OUTCOMES AND MEASURES

For each death, an expert multidisciplinary panel reviewed case data to determine the plausible pathway and causes of death. If the death was deemed preventable, the panel identified which of 10 predetermined health system gaps could have prevented the death. The health system improvements that could have prevented the most deaths were evaluated for each age group: stillbirths, neonatal deaths (aged <28 days), and infant and child deaths (aged 1 month to <5 years).

RESULTS

Of 3390 deaths, 1505 (44.4%) were female and 1880 (55.5%) were male; sex was not recorded for 5 deaths. Of all deaths, 3045 (89.8%) occurred in a healthcare facility and 344 (11.9%) in the community. Overall, 2607 (76.9%) were deemed potentially preventable: 883 of 1190 stillbirths (74.2%), 1010 of 1340 neonatal deaths (75.4%), and 714 of 860 infant and child deaths (83.0%). Recommended measures to prevent deaths were improvements in antenatal and obstetric care (recommended for 588 of 1190 stillbirths [49.4%], 496 of 1340 neonatal deaths [37.0%]), clinical management and quality of care (stillbirths, 280 [23.5%]; neonates, 498 [37.2%]; infants and children, 393 of 860 [45.7%]), health-seeking behavior (infants and children, 237 [27.6%]), and health education (infants and children, 262 [30.5%]).

CONCLUSIONS AND RELEVANCE

In this cross-sectional study, interventions prioritizing antenatal, intrapartum, and postnatal care could have prevented the most deaths among children younger than 5 years because 75% of deaths among children younger than 5 were stillbirths and neonatal deaths. Measures to reduce mortality in this population should prioritize improving existing systems, such as better access to antenatal care, implementation of standardized clinical protocols, and public education campaigns.

Use of antenatal and delivery care services and their association with maternal and infant mortality in rural India

Optimum use of antenatal care (ANC) and delivery care services could reduce morbidity and mortality among prospective mothers and their children. However, the role of ANC and delivery services in prevention of both maternal and child mortality is poorly understood, primarily because of dearth of prospective cohort data. Using a ten-years population-based prospective cohort data, this study examined the use of ANC and delivery services and their association with maternal and infant mortality in rural India. Descriptive statistics were estimated, and multivariable logistic regression modelling was used to attain the study objective. Findings revealed that consumption of ≥ 100 iron-and-folic acid (IFA) tablet/equivalent syrup during pregnancy had a protective association with maternal and infant mortality. Lack of maternal blood group checks during pregnancy was associated with increased odds of the death of infants. Caesarean/forceps delivery and delivery conducted by untrained personnel were associated with increased odds of maternal mortality. Findings from this study reemphasizes on increasing coverage and consumption of IFA tablets/equivalent syrup. Improved ANC and delivery services and increased uptake of all types of ANC and delivery care services are equally important for improvement in maternal and child survival in rural India.

Neonatal resuscitation from a global perspective

The majority of perinatal and neonatal mortality occurs in low-resource settings in low- and middle-income countries. Access and quality of care at delivery are major determinants of the health and survival of newborn infants. Availability of basic neonatal resuscitation care at birth has improved, but basic neonatal resuscitation at birth or high-quality care continues to be inaccessible in some settings, leading to persistently high perinatal and neonatal mortality. Low-resource settings of high-income countries and socially disadvantaged communities also suffer from inadequate access to quality perinatal healthcare. Quality improvement, implementation research, and innovation should focus on improving the quality of perinatal healthcare and perinatal and neonatal outcomes in low-resource settings. The current review presents an update on issues confronting universal availability of optimal resuscitation care at birth and provides an update on ongoing efforts to address them.

Factors associated with 5-min APGAR score, death and survival in neonatal intensive care: a case-control study

BACKGROUND

The 5-minute APGAR score is clinically used as a screening tool to assess how the newborn has reacted to previous care, remaining relevant for predicting neonatal survival. This study aimed to analyze the determinants of the 5th minute APGAR score, and the factors associated with the death and survival of newborns with low APGAR scores hospitalized in the neonatal intensive care unit (NICU) at a referral public hospital in North Brazil.

METHODS

This was a hospital-based retrospective case-control study with 277 medical records. Newborns who presented with a 1-minute APGAR score < 7 followed by a 5-minute APGAR score < 7 were considered cases, while a score ≥ 7 was categorized as controls. Univariate and multivariable logistic regression analyses were used to establish the determinant factors of the low APGAR score and death outcome in this group. Survival curves were obtained using the Kaplan-Meier estimator, and then univariate and multivariate Cox regression was performed.

RESULTS

After adjusted analysis, the factor associated with low APGAR scores was vaginal delivery (OR = 3.25, 95%CI = 1.60-6.62, p = 0.001). Birth injury (OR = 0.39, 95%CI = 0.19-0.83, p = 0.014) was associated with upper APGAR scores. No significant independent associations were observed between the variables analyzed and death in the low APGAR score group. The Kaplan-Meier curve showed that individuals who presented Cesarean delivery had a shorter survival time in the ICU.

CONCLUSION

In this setting, a 5-minute Apgar score < 7 was associated with the occurrence of vaginal delivery and birth injury with a 5-minute Apgar score ≥ 7. Survival in ICU was lower in newborns that were delivered via cesarean section.

Experience of a telehealth and education program with maternal and perinatal outcomes in a low-resource region in Colombia

INTRODUCTION

Maternal morbidity and mortality rates associated with perinatal care remain a significant public health concern. Rural populations from low and middle-income countries have multiple barriers to access that contribute to a lack of adherence to prenatal care, and high rates of maternal mortality and morbidity. An intervention model based on telehealth and education was implemented between a tertiary high complex care hospital and a second-level hospital from a limited source region.

OBJECTIVES

We sought to identify an association in maternal and perinatal care quality indicators after implementing a model based on telehealth and education for patients with obstetric emergencies between two hospitals in a southwestern region of Colombia.

METHODS

We conducted an ecological study between 2017 and 2019 to compare before and after obstetric emergency care through telemedicine from a secondary care center (Hospital Francisco de Paula Santander-HFPS) to the referral center (Fundación Valle del Lili-FVL). The intervention included verification visits to determine the installed capacity of care, a concerted improvement plan, and on-site educational training modules in obstetric and perinatal care.

RESULTS

There were 102 and 148 patients treated before and after telemedicine implementation respectively. Clinical indicators after model implementation showed a reduction in perinatal mortality of 29%. In addition, a reduction in the need for transfusion of blood products due to postpartum hemorrhage was observed as well as the rate of eclampsia.

CONCLUSIONS

Implementing a model based on telehealth and education between secondary and tertiary care centers allowed the strengthening of the security of care in obstetric emergencies and had a positive effect on perinatal mortality.

Determinants of neonatal near miss among neonates admitted to public hospitals in Southern Ethiopia, 2021: A case-control study

BACKGROUND

Neonatal near-miss (NNM) cases refer to situations in which babies are on the verge of dying between the ages of 0 and 28 days due to severe morbidity that occurs during pregnancy, delivery, or extra-uterine life, but survive either by luck or due to high-quality health care. Identifying NNM cases and addressing their determinants is crucial for devising comprehensive and relevant interventions to tackle neonatal morbidity and mortality. Hence, this study aimed at finding out the determinants of NNM in neonates admitted to public hospitals in Hadiya zone, southern Ethiopia.

METHODS

A hospital-based unmatched case-control study was conducted in three selected hospitals in southern Ethiopia from May 1 to June 30, 2021. A total of 484 participants took part in the study (121 cases and 363 controls). Controls were chosen using systematic sampling approaches, whereas cases were recruited consecutively at the time of discharge. Cases were selected based on the Latin American Centre for Perinatology (CLAP) criteria of an NNM. A structured interviewer-administered questionnaire and a data extraction checklist were used for data collection. The Data were entered into Epi-Data version 3.1 and exported to SPSS version 23 for analysis. A multivariable logistic regression analysis with a p-value of <0.05 was used to determine the determinants of NNM.

RESULTS

Ninety-seven (80.1%) and 56 (46.2%) near-miss cases encountered at least one pragmatic and management criteria, respectively. The most common pragmatic and management criteria were gestational age less than 33 weeks (44.6%) and intravenous antibiotic usage up to 7 days and before 28 days of life (27.3%), respectively. A short birth interval [AOR = 2.15, 95% CI: 1.29, 3.57], lack of ANC [AOR = 3.37; 95%CI: 1.35, 6.39], Caesarean mode of delivery [AOR = 2.24; 95%CI: 1.20, 4.16], the occurrence of a third maternal delay [AOR = 3.47; 95% CI: 2.11, 5.75], and poor birth preparedness and complication readiness (BPCR) plan[AOR = 2.50; 95% CI: 1.49,4.13] were identified as a significant determinants of NNM.

CONCLUSION AND RECOMMENDATION

The provision of adequate ANC should be a priority for health care providers at service delivery points. To avoid serious neonatal problems, mothers who deliver by Cesarean section should receive more attention from their families and health care providers. Health care providers in the ANC unit should encourage pregnant women to implement the WHO-recommended elements of the BPCR plan. To achieve optimal birth spacing, healthcare providers should focus on the contraceptive provision. Unnecessary delays in health facilities during childbirth should be avoided at all costs.

Factors associated with perinatal mortality in a Brazilian Northeastern capital

This study investigated factors associated with perinatal mortality in São Luís, Maranhão, Northeastern Brazil. Data on perinatal mortality were obtained from the BRISA birth cohort and from the Mortality Information System, including records of 5,236 births, 70 of which referred to fetal deaths and 36 to early neonatal deaths. Factors associated with mortality were investigated using a hierarchical logistic regression model, resulting in a perinatal mortality coefficient equal to 20.2 per thousand births. Mothers with low education level and without a partner were associated with an increased risk of perinatal death. Moreover, children of mothers who did not have at least six antenatal appointments and with multiple pregnancies (OR= 9.15; 95%CI:4.08-20.53) were more likely to have perinatal death. Perinatal death was also associated with the presence of congenital malformations (OR= 4.13; 95%CI:1.23-13.82), preterm birth (OR= 3.36; 95%CI:1.56-7.22), and low birth weight (OR=11.87; 95%CI:5.46-25.82). In turn, families headed by other family members (OR= 0.29; 95%CI: 0.12 - 0.67) comprised a protective factor for such condition. Thus, the results indicate an association between perinatal mortality and social vulnerability, non-compliance with the recommended number of prenatal appointments, congenital malformations, preterm birth, and low birthweight.

Perinatal mortality audit in a rural referral hospital in Tanzania to inform future interventions: A descriptive study

Background

Clear evidence exists that perinatal audit and feedback can lead to important improvements in practice. The death audit can lead to the identification of existing potential delays which are the decision to seek medical care, reaching an appropriate facility, and receiving timely adequate care at the facility. Such an audit potentially initiates a positive discussion, which may foster the implementation of changes that aims at saving more lives.

Objective

To review the perinatal deaths case notes and identify potential gaps in care provision and health-seeking behavior to foster best practice.

Methods

The stillbirths and neonatal death case notes that occurred between January 2019 and May 2020 at the hospital were reviewed using an adapted WHO checklist. The completed review case notes were entered into an electronic system and a quality control check-up was done. Data were analysed descriptively, and findings were presented in tables.

Results

There were 4,898 births, and 1,175 neonatal admissions, out of these there were 135 recorded stillbirths (2.8%) and 201(4.1% of the total hospital births) early neonatal deaths. Out of the 1,175 neonates, 635 (54%) were born within the hospital and 540 (46%) were admitted from other facilities and home deliveries. In total 86 stillbirths and 140 early neonatal deaths case notes were retrieved and audited. Out of 86 stillbirths’ case notes audited, 30 (34.9%) seemed to have died during labor, and of these 5 had audible fetal heart rate during admission. Apgar scores less than 7 at 5 minutes, prematurity, and meconium aspiration were the top three recorded causes of neonatal deaths. Inadequate/late antenatal care visits and home delivery were the maternal factors likely to have contributed to perinatal deaths. Inadequate labor monitoring (12%) and documentation (62%) were among the providers’ factors likely to have contributed to perinatal deaths.

Conclusion

This audit shows that there are high rates of preventable intrapartum stillbirths and early neonatal deaths. Both women and providers’ factors were found to have contributed to the stillbirths and neonatal deaths. There is a need to encourage women to adequately attend antenatal care, utilize health facilities during birth, and improve maternity and neonatal care at the health facilities.

Timely initiation of antenatal care and its associated factors among pregnant women in sub-Saharan Africa: A multicountry analysis of Demographic and Health Surveys

BACKGROUND

Timely initiation of antenatal care (ANC) is an important component of ANC services that improve the health of the mother and the newborn. Mothers who begin attending ANC in a timely manner, can fully benefit from preventive and curative services. However, evidence in sub-Saharan Africa (sSA) indicated that the majority of pregnant mothers did not start their first visit timely. As our search concerned, there is no study that incorporates a large number of sub-Saharan Africa countries. Thus, the objective of this study was to assess the prevalence of timely initiation of ANC and its associated factors in 36 sSA countries.

METHODS

The Demographic and Health Survey (DHS) of 36 sSA countries were used for the analysis. The total weighted sample of 233,349 women aged 15-49 years who gave birth in the five years preceding the survey and who had ANC visit for their last child were included. A multi-level logistic regression model was used to examine the individual and community-level factors that influence the timely initiation of ANC. Results were presented using adjusted odds ratio (AOR) with 95% confidence interval (CI).

RESULTS

In this study, overall timely initiation of ANC visit was 38.0% (95% CI: 37.8-38.2), ranging from 14.5% in Mozambique to 68.6% in Liberia. In the final multilevel logistic regression model:- women with secondary education (AOR = 1.08; 95% CI: 1.06, 1.11), higher education (AOR = 1.43; 95% CI: 1.36, 1.51), women aged 25-34 years (AOR = 1.20; 95% CI: 1.17, 1.23), ≥35 years (AOR = 1.30; 95% CI: 1.26, 1.35), women from richest household (AOR = 1.19; 95% CI: 1.14, 1.22), women perceiving distance from the health facility as not a big problem (AOR = 1.05; 95%CI: 1.03, 1.07), women exposed to media (AOR = 1.29; 95%CI: 1.26, 1.32), women living in communities with medium percentage of literacy (AOR = 1.51; 95%CI: 1.40, 1.63), and women living in communities with high percentage of literacy (AOR = 1.56; 95%CI: 1.38, 1.76) were more likely to initiate ANC timely. However, women who wanted their pregnancy later (AOR = 0.84; 95%CI: 0.82, 0.86), wanted no more pregnancy (AOR = 0.80; 95%CI: 0.77, 0.83), and women residing in the rural area (AOR = 0.90; 95%CI: 0.87, 0.92) were less likely to initiate ANC timely.

CONCLUSION

Even though the WHO recommends all women initiate ANC within 12 weeks of gestation, sSA recorded a low overall prevalence of timely initiation of ANC. Maternal education, pregnancy intention, residence, age, wealth status, media exposure, distance from health facility, and community-level literacy were significantly associated with timely initiation of ANC. Therefore, intervention efforts should focus on the identified factors in order to improve timely initiation of ANC in sSA. This can be done through the providing information and education to the community on the timing and importance of attending antenatal care and family planning to prevent unwanted pregnancy, especially in rural settings.

Magnitude and determinants of neonatal and postneonatal mortality in Goiânia, Goiás, Brazil: a retrospective cohort study, 2012

OBJECTIVE

To estimate magnitude and determinants of neonatal and postneonatal mortality rates in Goiânia, Brazil, 2012.

METHODS

This was a retrospective cohort study based on data linkage of the Live Birth Information System and the Mortality Information System. Logistic regression was used to evaluate factors associated with neonatal and postneonatal death.

RESULTS

Neonatal mortality (0-27 days of life) was 9.4 deaths per 1,000 live births; while postneonatal mortality (28-364 days of life) was 3.0 deaths per 1,000 live births. Neonatal mortality associated factors were: 0-3 prenatal care visits (OR=13.10 - 95%CI 7.48;22.96), 19-34-week pregnancy (OR=6.25 - 95%CI 2.26;17.29), birth weight <1,500g (OR=62.42 - 95%CI 22.72;171.48) and cesarean delivery (OR=0.54 - 95%CI 0.37;0.79). Postneonatal mortality associated factors were: 0-3 prenatal care visits (OR=4.16 - 95%CI 1.51;11.43) and birth weight <1.500g (OR=18.74 - 95%CI 4.04;87.00).

CONCLUSION

A low number of prenatal care visits, premature childbirth and low birth weight were the main risk factors for neonatal and postneonatal mortality.

The relationship between time spent during the first ANC contact, home visits and adherence to ANC contacts in Ghana

Background

The World Health Organization in 2016 recommended eight or more antenatal care (ANC) contacts for a positive pregnancy experience, however, it is unclear what impact the time spent during the first ANC contact and home visits can have on eight or more ANC contacts.

Objectives

Our study investigated the relationship between time spent during the first ANC contact and eight or more ANC contacts, and between home visits and eight or more ANC contacts. We also assessed the prevalence of eight or more ANC contacts.

Methods

A cross-sectional study was conducted among 519 mothers with children 12 months old and below attending child welfare clinics in the Nabdam district in the Upper East Region, Ghana. Multivariable logistic regression analysis was used to assess the relationship between time spent during the first ANC contact, home visits, and eight or more ANC contacts, while controlling for potential confounders.

Results

The proportion of mothers who attained eight or more ANC contacts during pregnancy was 31.2%. Spending 20 minutes or more during the first ANC contact was associated with 2.07 times the odds of having eight or more ANC contacts compared to spending less than 20 minutes [adjusted odds ratio (aOR): 2.07, 95% CI: 1.18,3.63]. Mothers who received at least a home visit from skilled health professionals during pregnancy were 2.44 times more likely to have eight or more ANC contacts compared to mothers who were not visited (aOR: 2.44, 95% CI: 1.51,3.94).

Conclusion

Spending at least 20 minutes during the first ANC contact and home visits were positively associated with eight or more ANC contacts. We recommend that skilled health professionals should spend at least 20 minutes during the first ANC contact as well as encourage home visits in order to increase the coverage of eight or more ANC contacts.