Effect of optimal antenatal care on maternal and perinatal health in Ethiopia

Inequality in maternal delays related to maternal death at home and en route to a health facility in Ethiopia: insights from national mortality surveillance data

OBJECTIVE

This study aims to quantify and identify the contributors to inequity in the maternal mortality risk index for deaths occurring at home and en route to health facilities.

DESIGN AND SETTING

Analysis of the Maternal Death Surveillance and Response data, encompassing maternal deaths reviewed in Ethiopia from 2013 to 2020.

ANALYSIS

The Maternal Mortality Risk Index was computed using 14 variables grouped according to the three contributors to delay model: contributors to delay in seeking care, contributors to delay in reaching care and contributors to delay in receiving optimal care. Principal component analysis was employed to calculate the index descriptive statistics, and the Erreygers Normalised Concentration Index (ECI) measured inequalities in the maternal mortality risk index across different places of death. Blinder-Oaxaca decomposition analysis identified factors contributing to these disparities in maternal deaths at home and intransit.

PARTICIPANTS

A total of 4530 reviewed maternal deaths were included in this study.

RESULTS

ECI was 0.18 (SE 0.02) for maternal deaths occurring at home and 0.12 (SE 0.01) for those en route to a health facility, indicating a higher concentration of deaths among women with a high maternal mortality risk index in both settings. Decomposition analysis identified marital status, educational status, maternal parity and residence as the key contributors to this disparity.

CONCLUSION

A notable disparity in the maternal mortality risk index was observed, with home and intransit deaths predominantly affecting women with a high maternal mortality risk index. To reduce these inequalities, efforts should be made to improve community health-seeking behaviour and establish effective referral linkages.

Prevalence, underlying causes, and determinants of maternal near miss in Ethiopia: a systematic review and meta-analysis

Background

Maternal near miss (MNM) is one of the newly adopted assessment parameters to gauge the quality of maternity care. In Ethiopia, several studies have been conducted to investigate the incidence, underlying causes, and determinants of MNM. However, the findings from those studies vary greatly and are largely inconsistent. Thus, this review aims to more robustly estimate the pooled prevalence, identify underlying causes, and single out determinants of MNM in Ethiopia.

Methods

Studies were searched from international databases (PubMed/ Medline, Cochrane Library, and Embase databases) and other potential sites. All observational studies were included. Heterogeneity between studies was checked using Cochrane Q test statistics and I2 test statistics and small study effects were checked using Egger's statistical test at a 5% significance level. Outcome measures were overall and specific underlying causes (obstetrics hemorrhage, hypertensive disorder pregnancy, pregnancy-related infection) rates of MNMs per 10,000 live births.

Result

The meta-analysis included 43 studies consisting of 77240 MNM cases. The pooled prevalence MNM per 1000 live births in Ethiopia was 54.33 (95% CI: 33.93 to 85.89). Between-study heterogeneity was high (I2 = 100%, P < 0.0001), with the highest rate observed in Amhara region (384.54 per 1000). The prevalence of obstetrics hemorrhage (14.56 per 1000) was higher than that of hypertensive disorder pregnancy (12.67 per 1000) and pregnancy-related infections (3.55 per 1000) were identified as underlying causes. Various factors, including socio demographic characteristics, previous medical and obstetrics history as well as access to and quality of care obtained, were associated with MNM.

Conclusion

Almost six women encounter near miss among a hundred live births in Ethiopia. Obstetric hemorrhage and hypertensive disorder pregnancy were the most common underlying causes of MNM. Both individual and facility level determinants were found to be associated with MNM. Considering the magnitude and identified factors, tailored measures should be taken at every stage of the continuum of care.

Systematic review registration

https://www.crd.york.ac.uk/prospero/, identifier CRD42023395259.

Complete continuum of care for maternal health services and determinants among mothers who gave birth in the last year in Chiro City, Eastern Ethiopia: a community-based cross-sectional study (2024)

Introduction

Ethiopia has one of the highest maternal death rates in the world, with 412 deaths for every 100,000 live births. A qualified healthcare professional's care during pregnancy, delivery, and the postnatal period is crucial to saving the lives of the mother and her child. The continuum of maternity health services in Ethiopia is still shallow, despite efforts to increase the use of these services. This study's goal was to evaluate the magnitude and factors influencing the entire continuum of care for maternal health services in Chiro City in 2024.

Methods

A community-based cross-sectional study was conducted from 15 January to 15 February 2024, among mothers who gave birth in the last year preceding the data collection period in Chiro City, Eastern Ethiopia. Data were collected through face-to-face interviews using a structured questionnaire. Multivariable logistic regression analysis was done to identify determinants of the complete continuum of care. A P-value of <0.05 was considered statistically significant in this study.

Result

The prevalence of a complete continuum of care among mothers who gave birth in the last year in Chiro District was 37.0%. Accordingly, women who received ANC were 5.24 times more likely to complete the maternal health services continuum of care compared with their counterparts (AOR: 5.24, 95% CI: 1.94, 14.15). Compared with their counterparts, women who received health education were 4.36 times more likely to complete the continuum of care (AOR: 4.36, 95% CI: 2.0, 9.51). Similarly, women who had planned pregnancies were 4.32 times more likely to complete the maternal health services continuum of care than those who had unplanned pregnancies (AOR: 4.32, 95% CI: 2.38, 7.85).

Conclusion and recommendation

The continuum of care was favorably correlated with ANC usage, health education, and planned pregnancies. To increase the coverage of the entire continuum of maternal care, it is desirable to develop programs that encourage women to initiate ANC contacts, provide health education, and promote planned pregnancies.

Why does the number of antenatal care visits in Ethiopia remain low?: A Bayesian multilevel approach

INTRODUCTION

Antenatal care (ANC) visit is a proxy for maternal and neonatal health. The ANC is a key indicator of access and utilization of health care for pregnant women. Recently, eight times ANC visits have been recommended during the pregnancy period. However, nearly 57% of women received less than four ANC visits in Ethiopia. Therefore, the objective of this study is to identify factors associated withthe number of ANC visits in Ethiopia.

METHODS

A community-based cross-sectional study design was conducted from March 21 to June 28/2019. Data were collected using interviewer-administered questionnaires from reproductive age groups. A stratified cluster sampling was used to select enumeration areas, households, and women from selected households. A Bayesian multilevel negative binomial model was applied for the analysis of this study. There is an intra-class correlation (ICC) = 23.42% and 25.51% for the null and final model, respectively. Data were analyzed using the STATA version 17.0. The adjusted incidence risk ratio (IRR) with 95% credible intervals (CrI) was used to declare the association.

RESULT

A total of 3915 pregnant women were included in this study. The mean(SD) age of the participants was 28.7 (.11) years. Nearly one-fourth (26.5%) of pregnant women did not have ANC visits, and 3% had eight-time ANC visits in Ethiopia. In the adjusted model, the age of the women 25-28 years (IRR:1.13; 95% CrI: 1.11, 1.16), 29-33 years (IRR: 1.15; 95% CrI: 1.15, 1.16), ≥34 years (IRR:1.14; 95% CrI: 1.12, 1.17), being a primary school (IRR: 1.22, 95% CrI: 1.21, 1.22), secondary school and above (IRR: 1.26, 95% CrI: 1.26, 1.26), delivered in health facility (IRR: 1.93; 95% CrI: 1.92, 1.93), delivered with cesarian section (IRR: 1.18; 95% CrI: 1.18, 1.19), multiple (twin) pregnancy (IRR: 1.11; 95% CrI: 1.10, 1.12), richest (IRR:1.23; 95% CrI: 1.23, 1.24), rich family (IRR: 1.34, 95% CrI: 1.30, 1.37), middle income (IRR: 1.29, 95% CrI: 1.28, 1.31), and poor family (IRR = 1.28, 95% CrI:1.28, 1.29) were shown to have significant association with higher number of ANC vists, while, households with total family size of ≥ 5 (IRR: 0.92; 95% CrI: 0.91, 0.92), and being a rural resident (IRR: 0.92, 95% CrI: 0.92, 0.94) were shown to have a significant association with the lower number of ANC visits.

CONCLUSION

Overall, 26.5% of pregnant women do not have ANC visits during their pregnancy, and 3% of women have eight-time ANC visits. This result is much lower as compared to WHO's recommendation, which states that all pregnant women should have at least eight ANC visits. In this study, the ages of the women 25-28, 29-33, and ≥34 years, being a primary school, secondary school, and above, delivered in a health facility, delivered with caesarian section, multiple pregnancies, rich, middle and poor wealth index, were significantly associated with the higher number of ANC visits, while households with large family size and rural residence were significantly associated with a lower number of ANC visits in Ethiopia.

Prevalence and determinants of adverse perinatal outcomes of preeclampsia with severe features at two selected public hospitals in Addis Ababa, Ethiopia

Background

Preeclampsia is a new onset of hypertension and either proteinuria or end-organ failure after 20 weeks of gestation. It is a prevalent cause of perinatal mortality, morbidity, and neonatal complications in developing nations including Ethiopia. Thus, the aimed to assess the prevalence and determinants of adverse perinatal outcomes among women with preeclampsia with severity features (PEWSF) at two selected public hospitals in Addis Ababa, Ethiopia, 2023.

Method

A cross-sectional study was carried out among 348 mothers between January 1, 2023, and July 1, 2023. A structured, pre-tested questionnaire was used to gather data from in-person interviews and a review of the patient's medical record. The statistical program Epi-Data version 4.6 was used to enter the data, and SPSS version 26.0 was used for analysis. Binary logistic regression analysis was used to find factors that were associated with unfavorable perinatal outcomes. A p-value of less than 0.05 was used to declare the significance level.

Result

The overall prevalence of unfavorable perinatal outcomes was 59.2% (95% CI: 54.0-63.8). Among the complications, low birth weight, prematurity, NICU admission, and a low fifth-minute APGAR score, encompass 48.9%, 39.4%, 20.4%, and 14.7%, respectively. No formal education [OR = 5.14, 95% CI: (1.93-13.63)], unemployment [OR = 0.42, 95% CI: (0.24-0.73)], referral cases [OR = 2.03, 95% CI: (1.08-4.06), inadequate antenatal care (ANC) contact [OR = 3.63, 95% CI: (1.22-10.71)], and family history of hypertension [OR = 1.99, 95% CI: (1.03-3.85)] have shown a statistically significant association with unfavorable perinatal outcomes.

Conclusion

In this study, the prevalence of unfavorable perinatal outcomes was high compared to other studies in Ethiopia. Level of education, occupation, mode of admission, ANC contact, and family history of hypertension were significant predictors of unfavorable perinatal outcomes. Socio-economic development, improving referral systems, and adequate antenatal care contact are needed to improve unfavorable outcomes. Additionally, antenatal screening and specialized care for high-risk mothers, e.g., those with a family history of hypertension are recommended.

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.

Utilisation of Maternal Health Services and its Impact on Maternal Mortality Rate: A Case for KwaZulu-Natal, South Africa

Despite several strategies in place in South Africa and globally to prevent maternal mortality and morbidity, maternal deaths remain high, especially in sub-Saharan Africa and lower to middle-income countries. The aim of the study was to identify the challenges that lead to pregnant women’s delays in seeking antenatal care (ANC) early and to find strategies to prevent such delays, contributing to a reduction of maternal deaths in South Africa. The study was conducted in two phases. Phase one analysed data on maternal deaths collected by the District Health Information System (DHIS) of the KwaZulu-Natal Department of Health from all 11 districts over a 10-year period (2009–2019). The data on maternal deaths revealed that there was a very high maternal mortality rate; between 800 and 1 780 per 100 000 live births. This correlated with very low antenatal visits; between 695–895 per 100 000 live births. In phase two, a literature review was conducted using several computer-assisted databases, bibliographies and websites to identify and source current policies. The literature review presents causes of delay in seeking ANC and strategies to prevent maternal deaths. Recommendations were made to consider strengthening education and awareness related to family planning; women empowerment through community health programmes and change in healthcare providers’ behaviours and attitudes; ensuring availability of maternal health resources; and developing strategies to ensure that the ANC services delivered are in line with the South African Department of Health Guidelines.

Sociodemographic Predictors of Initiating Antenatal Care Visits by Pregnant Women During First Trimester of Pregnancy: Findings from the Afghanistan Health Survey 2018

Purpose

Initiating antenatal care (ANC) visits by pregnant women during first trimester, known as timely initiation of ANC visits, is crucial for wellbeing of mothers and their unborn babies. We examined whether sociodemographic characteristics of pregnant women predict timely initiation of ANC visits.

Patients and Methods

Data collected for the Afghanistan Health Survey 2018 (AHS 2018) were analyzed. A binary outcome variable was created as women with ANC visits in 0-3 months (first trimester) vs women with ANC visits in ≥4 months of pregnancy. A multivariable generalized linear model was employed.

Results

A total of 6862 ever-married women, aged 14-49 years, with a history of pregnancy, including current pregnancy, were included. The prevalence of timely initiation of ANC visits was 55.8%. The likelihood (OR = odds ratio) of timely initiation of ANC visits was higher in women aged 30-39 years [OR 1.12 (95% CI: 1.00-1.25)], in women who could read and write [OR 1.12 (95% CI: 0.99-1.21)], in women who used public primary care facilities [OR 1.14 (95% CI: 1.01-1.28)], in women who received consultation on ANC from a doctor or midwife [OR 1.22 (95% CI: 0.72-2.08), OR 1.13 (95% CI: 0.67-1.92)] respectively, in women at fourth and highest quintiles of wealth status [OR 1.24 (95% CI: 1.04-1.48), OR 1.14 (95% CI: 0.92-1.40)] respectively, in women who intended to become pregnant [OR 1.56 (95% CI: 1.35-1.81)], in women who used the internet [OR 1.53 (95% CI: 1.13-2.06)], and in women who listened to radio [OR 1.16 (95% CI: 1.03-1.30)]. However, the likelihood was lower in women who had given birth at least twice [OR 0.67 (95% CI: 0.50-0.89)], and in women who lived in rural areas [OR 0.87 (95% CI: 0.75-1.00)].

Conclusion

To promote timely initiation of ANC visits, healthcare interventions to increase availability of midwives and doctors, and improve accessibility to primary care clinics, especially in rural areas, need to be implemented.