Perinatal care in Western Uganda: Prevalence and factors associated with appropriate care among women attending three district hospitals

A secondary analysis of the factors associated with women´s adequate utilization of antenatal care services during their last pregnancy in Uganda

BACKGROUND

Adequate antenatal care services (ANC) use is critical to identifying and reducing pregnancy risks. Despite the importance placed on adequate antenatal care service utilization, women in Uganda continue to underutilize antenatal care services. The primary goal of this study is to identify the factors associated with women's adequate utilization of antenatal care services in Uganda.

METHODS

Secondary data from the 2016 Uganda Demographic and Health Survey were used in this study. The study sample consists of 9,416 women aged 15 to 49 who reported giving birth in the five years preceding the survey. The adequate use of antenatal care services is the dependent variable. A woman who used antenatal care services at least four times is considered to have adequately used antenatal care services. We used univariate, bivariate, and multilevel logistic regression modelling to identify the factors associated with adequate utilization of antenatal care services. STATA version 14.2 was used to analyze the data.

RESULTS

The prevalence of adequate utilization of antenatal care services in Uganda was found to be 61.4%. Women with secondary or higher education were 32.0% (AOR = 1.32, 95% CI;1.07-1.63), employed women were 26.0% (AOR = 1.26, 95% CI;1.10-1.44), women who received high-quality antenatal care content were 78.0% (AOR = 1.78, 95% CI;1.58-2.02), and women who belong to the rich category of the wealth index bracket were 27.0% (AOR = 1.27, 95% CI;1.09-1.49), more likely to use antenatal care services adequately. Finally, the study discovered that women from less diverse ethnic communities were 15.0% (AOR, 0.85, 95%CI; 0.73-0.99) less likely to use antenatal care services adequately.

CONCLUSION

Women's adequate utilization of antenatal care was influenced by both community and individual-level characteristics. Policymakers must use a multi-sectoral approach to develop policies that address both individual and community-level characteristics.

Insights of Parents and Parents-To-Be in Using Chatbots to Improve Their Preconception, Pregnancy, and Postpartum Health: A Mixed Studies Review

INTRODUCTION

Chatbots, which are also known as conversational or virtual agents, are digital programs that can interact with humans using voice, text, or animation. They have shown promise in providing preconception, pregnancy, and postpartum care. This review aims to consolidate the insights of parents and parents-to-be in using chatbots to improve their preconception, pregnancy, and postpartum health.

METHODS

Seven electronic databases were searched from their inception dates until April 2022 (PubMed, Embase, CINAHL, PsycINFO, Web of Science, Scopus, and ProQuest Dissertations and Theses Global) for relevant studies. English language primary studies that were conducted on parents or parents-to-be aged ≥18 years old who had undergone interventions involving the use of any type of chatbot were included in this review. The quality of included studies was appraised using the Mixed Methods Appraisal Tool. A convergent qualitative synthesis design for mixed studies reviews was used to synthesize the findings, and results were thematically analyzed.

RESULTS

Fifteen studies met the inclusion criteria: quantitative (n = 11), qualitative (n = 1), and mixed method (n = 3). Three main themes were identified: (1) welcoming a new health resource, (2) obstacles blocking the way, and (3) moving toward a digital health era.

DISCUSSION

Parents and parents-to-be appreciated the informational, socioemotional, and psychological support provided by chatbots. Recommendations for technological improvements in the functionality of the chatbots were made that include training sessions for health care providers to familiarize them with this new digital technology. Multidisciplinary chatbot development teams could also be established to develop more comprehensive chatbot-delivered health programs for more diverse populations.

Midwives' perceptions towards the ministry of health guidelines for the provision of immediate postpartum care in rural health facilities in Uganda

BACKGROUND

Guidelines for clinical practice have been part of the Ministry of health's efforts to improve the quality of care for over two decades. Their benefits have been documented in Uganda. However, having practice guidelines may not always result in their use in care provision. We explored the midwives' perceptions towards the ministry of health guidelines for providing immediate postpartum care.

METHODS

An exploratory descriptive qualitative study was conducted in three districts in Uganda from September 2020 to January 2021. In-depth interviews with 50 midwives from 35 health centers and 2 hospitals in Mpigi, Butambala, and Gomba districts were done. Thematic analysis of data was done.

RESULTS

Three themes emerged; awareness and use of the guidelines, perceived drivers, and perceived barriers to the provision of immediate postpartum care. The subthemes for theme I included; awareness of the guidelines, variations in the postpartum care practices, variations in preparedness to manage women with complications, and varied access to continuing midwifery education. Fear of complications and litigation were the perceived drivers of guideline use. On the other hand, lack of knowledge, busy maternity units, organization of the care, and the midwives' perceptions about their clients were the barriers to guideline use. Midwives felt that new guidelines and policies regarding immediate postpartum care should be disseminated widely.

CONCLUSION

The midwives felt that the guidelines were good for the prevention of postpartum complications but their knowledge of the guidelines for the provision of immediate postpartum care was suboptimal. They desired on-job training and mentorship to help them bridge the knowledge gaps. Variations in patient assessment, monitoring, and pre-discharge care were acknowledged and said to be due to a poor reading culture and health facility factors like patient-midwife ratios, unit setup, and prioritization of labor.

Factors associated with Women’s timing of first antenatal care visit during their last pregnancy: evidence from 2016 Uganda demographic health survey

Background

Utilization of antenatal care services (ANC) during pregnancy has been recognized as a major public health intervention to abate maternal morbidity and mortality. Uganda has experienced high levels of maternal morbidity and mortality over the past two decades. This could be partly attributed to the lower proportion of women who initiated their first antenatal care visit during the first trimester of their gestation period. This study aimed at investigating the factors associated with timing of first ANC visit by women in Uganda.

Method

This study used secondary data from the 2016 Uganda Demographic and Health Survey (UDHS). The study population comprises of women aged 15–49 who reported to have given their last birth during the five years preceding the 2016 UDHS survey. The outcome variable for this study was the timing of first ANC visit. Univariate, bivariate, and multilevel binary logistic regression analysis was used to determine the factors associated with the utilization of timing of first ANC visit.

Results

Findings show that only 30% [95%CI; 0.28–0.31] of women utilized ANC during the first trimester. Women of higher parity (4+) were less likely to utilize ANC in the first trimester compared to the lower parity (1) (AOR, 0.74, CI; 0.60–0.92). Women who reside in communities with good access to health facility were more likely to utilize ANC during the first trimester as compared to women residing in communities inaccessible to health facility (AOR, 1.36, CI; 1.04–1.77). Women who reside in less diverse ethnic communities were less likely to utilize ANC in the first trimester compared to their counterparts (AOR, 0.15, CI; 0.11–0.22).

Conclusion

This study demonstrated that contextual factors are important predictors of utilization of ANC during the first trimester apart from individual, factors. It is thus important for maternal health programme interventions to consider both individual and contextual factors when encouraging women to utilize ANC services during the first trimester.

Do in-service training materials for midwifery care providers in sub-Saharan Africa meet international competency standards? A scoping review 2000-2020

BACKGROUND

Levels of maternal and neonatal mortality remain high in sub-Saharan Africa, with an estimated 66% of global maternal deaths occurring in this region. Many deaths are linked to poor quality of care, which in turn has been linked to gaps in pre-service training programmes for midwifery care providers. In-service training packages have been developed and implemented across sub-Saharan Africa in an attempt to overcome the shortfalls in pre-service training. This scoping review has aimed to summarize in-service training materials used in sub-Saharan Africa for midwifery care providers between 2000 and 2020 and mapped their content to the International Confederation of Midwives (ICM) Essential Competencies for Midwifery Practice.

METHODS

Searches were conducted for the years 2000-2020 in Cumulative Index of Nursing and Allied Health Literature, PubMed/MEDLINE, Social Science Citation Index, African Index Medicus and Google Scholar. A manual search of reference lists from identified studies and a search of grey literature from international organizations was also performed. Identified in-service training materials that were accessible freely on-line were mapped to the ICM Essential Competencies for midwifery practice.

RESULTS

The database searches identified 1884 articles after removing duplicates. After applying exclusion criteria, 87 articles were identified for data extraction. During data extraction, a further 66 articles were excluded, leaving 21 articles to be included in the review. From these 21 articles, six different training materials were identified. The grey literature yielded 35 training materials, bringing the total number of in-service training materials that were reviewed to 41. Identified in-service training materials mainly focused on emergency obstetric care in a limited number of sub-Saharan Africa countries. Results also indicate that a significant number of in-service training materials are not readily and/or freely accessible. However, the content of in-service training materials largely met the ICM Essential Competencies, with gaps noted in the aspect of woman-centred care and shared decision making.

CONCLUSION

To reduce maternal and newborn morbidity and mortality midwifery care providers should have access to evidence-based in-service training materials that include antenatal care and routine intrapartum care, and places women at the centre of their care as shared decision makers.