Family context and individual characteristics in antenatal care utilization among adolescent childbearing mothers in urban slums in Nigeria

Introduction Adolescent pregnancy contributes significantly to the high maternal mortality in Nigeria. Research evidence from developing countries consistently underscores Antenatal Care (ANC) among childbearing adolescents as important to reducing high maternal mortality. However, more than half of pregnant adolescents in Nigeria do not attend ANC. A major gap in literature is on the influence of family context in pregnant adolescent patronage of ANC services. Methods The study utilized a cross-sectional survey with data collected among adolescent mothers in urban slums in three Nigerian states namely, Kaduna, Lagos, and Oyo. The survey used a multi-stage sampling design. The survey covered a sample of 1,015, 1,009 and 1,088 childbearing adolescents from each of Kaduna, Lagos, and Oyo states respectively. Data were analyzed at the three levels: univariate, bivariate and multivariate. Results Overall, about 70 percent of female adolescents in our sample compared with 75 percent in the Demographic and Health Survey (DHS) had any antenatal care (ANC) visit. About 62 percent in our sample compared with 70 percent in the DHS had at least 4 ANC visits, and, about 55 percent in our sample compared with 41 percent of the DHS that had 4 ANC visits in a health facility with skilled attendant (4ANC+). Those who have both parents alive and the mother with post-primary education have higher odds of attending 4ANC+ visits. The odds of attending 4ANC+ for those who have lost both parents is almost 60% less than those whose parents are alive, and, about 40% less than those whose mothers are alive. The influence of mother’s education on 4ANC+ attendance is more significant with large disparity when both parents are dead. Conclusion The study concludes that identifying the role of parents and community in expanding access to ANC services among adolescent mothers is important in improving maternal health in developing countries.

An assessment of health facility factors influencing male participation in utilization of antenatal care services among spouses in selected manufacturing industries in Nairobi County, Kenya

Background: Male participation in utilization of reproductive health is likely to promote timely and proper antenatal care, encourage women to deliver under the care of a skilled attendant, and also help identify and seek heath care in cases of post-partum complications. However, in most African societies, pregnancy, delivery and postnatal services has been erroneously classified as purely feminine issue by the society.Methods: A cross-sectional descriptive study design was adopted for the study. The target population of the study comprised of males above 18 years working in selected manufacturing industries in the area of Babadogo located in Nairobi County, Kenya. The sample size for the study was 266 respondents. Structured questionnaires were used for data collection. Data collected was quantitatively analysed using Statistical Package for Social Sciences (SPSS).Results: 56.0% (145) of the respondents had accompanied their partner to antenatal care facilities; 34.0% (88) of the respondents had ever participated in ANC services. Chi-square test statistics showed that distance to the nearest health facility (χ2=7.472 df=3, p=0.024), cost of accessing ANC services (χ2=26.253 df=4, p=0.001), attitude of healthcare providers (χ2=31.705 df=3, p=0.001) and friendliness of the waiting bay (χ2=9.718 df=2, p=0.008) significantly influenced male participation in antenatal care services’ utilization among spouses.Conclusions: Despite majority of men accompanying their wives to antenatal care facilities, most of them did not participate in the antenatal care services. Another conclusion is that facility factors such as distance, cost, health care providers’ attitude, and waiting bay friendliness influence male participation in utilization of antenatal care services.

Spatial patterns and inequalities in skilled birth attendance and caesarean delivery in sub-Saharan Africa

BackgroundImproved access to and quality obstetric care in health facilities reduces maternal and neonatal morbidity and mortality. We examined spatial patterns, within-country wealth-related inequalities and predictors of inequality in skilled birth attendance and caesarean deliveries in sub-Saharan Africa.MethodsWe analysed the most recent Demographic and Health Survey data from 25 sub-Saharan African countries. We used the concentration index to measure within-country wealth-related inequality in skilled birth attendance and caesarean section. We fitted a multilevel Poisson regression model to identify predictors of inequality in having skilled attendant at birth and caesarean section.ResultsThe rate of skilled birth attendance ranged from 24.3% in Chad to 96.7% in South Africa. The overall coverage of caesarean delivery was 5.4% (95% CI 5.2% to 5.6%), ranging from 1.4% in Chad to 24.2% in South Africa. The overall wealth-related absolute inequality in having a skilled attendant at birth was extremely high, with a difference of 46.2 percentage points between the poorest quintile (44.4%) and the richest quintile (90.6%). In 10 out of 25 countries, the caesarean section rate was less than 1% among the poorest quintile, but the rate was more than 15% among the richest quintile in nine countries. Four or more antenatal care contacts, improved maternal education, higher household wealth status and frequently listening to the radio increased the rates of having skilled attendant at birth and caesarean section. Women who reside in rural areas and those who have to travel long distances to access health facilities were less likely to have skilled attendant at birth or caesarean section.ConclusionsThere were significant within-country wealth-related inequalities in having skilled attendant at birth and caesarean delivery. Efforts to improve access to birth at the facility should begin in areas with low coverage and directly consider the needs and experiences of vulnerable populations.

Improved Water or Sanitation and Utilization of Maternal and Child Health Services in South Asia—An Analysis of Demographic Health Surveys

Globally, many millions of people still lack access to safe drinking water and sanitation facilities. Here, we examined whether household availability of improved drinking water and sanitation, respectively, is associated with utilization of maternal and child health (MCH) services in South Asia. Demographic and Health Survey population-based data from Bangladesh, Nepal, India, and Pakistan were used, restricted to women with a child aged 0–36 months (n = 145,262). Types of households’ water source and sanitation facilities were categorized based on the World Health Organization and UNICEF’s definitions of “improved” and “unimproved”. We applied logistic regressions to estimate odds ratios (OR) and 95% confidence intervals (CI) for improved water and sanitation, respectively, in relation to reported antenatal care visits, having a skilled attendant at birth, and infant vaccination coverage, stratified by maternal education. Among lower educated women, access to improved water was associated with greater ORs for presence of a skilled attendant at delivery and their children having up-to-date immunizations (OR: 1.29; 95% CI: 1.17, 1.42). Among lower and higher educated women, improved sanitation (vs. unimproved) was associated with greater ORs for having had adequate antenatal care visits (OR: 1.74; 95% CI: 1.62, 1.88; OR: 1.71; 95% CI: 1.62, 1.80), and similarly for having had a skilled attendant at birth, and children with up-to-date immunizations. MCH services and water/sanitation should be addressed across sectors aiming at improvement of MCH.

Prevalence and predictors of timely initiation of breastfeeding in Ghana: an analysis of 2017–2018 multiple indicator cluster survey

Background Timely initiation of breastfeeding is putting the newborn baby to the breast within 1 h of birth. Its practice can prevent neonatal and under-5 mortality. This study aims to assess the prevalence and factors associated with timely initiation of breastfeeding among mothers in Ghana. Methods We used data from the 2017–2018 Ghana multiple indicator cluster survey and our analysis was restricted to 3466 mothers who had a live birth within 2 years. Multivariable logistic regression was used to estimate the factors associated with timely initiation of breastfeeding whilst adjusting for potential confounders, and accounted for clustering, stratification, and sample weights. Results The prevalence of timely initiation of breastfeeding was 52.3% (95% CI 49.7%, 54.9%). Mothers who were assisted by a skilled attendant at birth had 65% higher odds of timely initiation of breastfeeding compared to mothers who were not assisted by a skilled attendant (adjusted prevalence odds ratio [aPOR] 1.65; 95% CI 1.28, 2.13). Mothers who delivered by Caesarean section had 74% lower odds of timely initiation of breastfeeding compared to mothers who had vaginal delivery (aPOR 0.26; 95% CI 0.18, 0.36). Mothers who had planned their pregnancy had 31% higher odds of timely initiation of breastfeeding compared to mothers who had an unplanned pregnancy (aPOR 1.31; 95% CI 1.05, 1.63). There were also 74% and 51% higher odds of timely initiation of breastfeeding among mothers who perceived their baby was large (aPOR 1.74; 95% CI 1.34, 2.26), and of average size (aPOR 1.51, 95% CI 1.16, 1.97) at birth respectively, compared to mothers who perceived their baby was small. Conclusions Interventions to increase timely initiation of breastfeeding should provide breastfeeding support to mothers who have had a Caesarean section, small sized babies and unplanned pregnancies, and to promote birthing by skilled birth attendants.

Post-Partum Hemorrhage is still killing mothers in Bangladesh: Inhaled oxytocin (IHO) can help

The main cause of maternal death in Bangladesh is postpartum hemorrhage (PPH). PPH accounts for 31%of maternal deaths. Proven interventions to prevent maternal mortality are active management of third stage of labour (AMTSL) and the availability of comprehensive emergency obstetric care (CEmOC); both include the administration of oxytocin. Traditional parenteral oxytocin administration requires a consistent cold chain and for a skilled attendant to administer the injection. Inhaled oxytocin (IHO), which does not require a cold chain, has been shown to have similar efficacy to parenteral oxytocin, in preventing PPH. In Bangladesh there are non-functioning institutionalized guidelines from the Director General of Health Services on the storage of parenteral oxytocin, which may impact the potency of oxytocin used during labour. To reduce preventable PPH morbidity and mortality, Bangladesh needs to consider replacing parenteral oxytocin with IHO, as the cold chain capacity in Bangladesh is strained, and institutional guidelines for injectable oxytocin are not used. In parallel, Bangladesh should also continue efforts to ensure universal access to quality AMSTL and CEmOC services.

Prevalence and predictors of timely initiation of breastfeeding in Ghana: an analysis of 2017–2018 multiple indicator cluster survey

Background Timely initiation of breastfeeding is putting the newborn to the breast within 1 h of birth. Its practice can prevent neonatal and under-5 mortality. This study aims to assess the prevalence and factors associated with timely initiation of breastfeeding among mothers in Ghana. Methods We used data from the 2017–2018 Ghana multiple indicator cluster survey and our analysis was restricted to 15,305 mothers who had a live birth within 2 years. Multivariable logistic regression was used to estimate the factors associated with timely initiation of breastfeeding whilst adjusting for potential confounders, and accounted for clustering, stratification, and sample weights. Results The prevalence of timely initiation of breastfeeding was 51.3% (95% CI 48.1, 54.6%). Mothers who received antenatal care were twice as likely to timely initiate breastfeeding compared to mothers who did not receive antenatal care (Adjusted prevalence odds ratios [aPOR] 2.01, 95% CI 1.03, 3.95). Mothers who were assisted by a skilled attendant at birth had 90% higher odds of timely initiation of breastfeeding compared to mothers who were not assisted by a skilled attendant (aPOR 1.90, 95% CI 1.41, 2.55). Mothers who delivered by caesarean section had 76% lower odds of timely initiation of breastfeeding compared to mothers who had a vaginal delivery (aPOR 0.24, 95, 95% CI 0.16, 0.36). Mothers who had planned their pregnancy had 45% higher odds of timely initiation of breastfeeding compared to mothers who had an unplanned pregnancy (aPOR 1.45, 95% CI 1.09, 1.92). There were also 84% and 55% higher odds of timely initiation of breastfeeding among mothers who perceived their baby was large (aPOR 1.84, 95% CI 1.32, 2.58), and of average size (aPOR 1.55, 95% CI 1.11, 2.17) at birth respectively, compared to mothers who perceived their baby was small. Conclusions Interventions to increase timely initiation of breastfeeding should provide breastfeeding support to mothers who have had a caesarean section or small sized babies, prevent unplanned pregnancies, and promote antenatal care attendance among pregnant women.

STUDY ON STILL BIRTH: A CATASTROPH FOR PATIENT AND NIGHTMARE FOR THE OBSTETRICIAN

Introduction: Still Birth is a catastrophic event for both treating doctor and the patient.World wide in 2015, for every 1000 total births, 18.4 babies were stillborn, mostly in low and middle income countries. India has the highest number of stillbirths, with an estimated 592 100 deaths per year Aim : To evaluate the still birth rate of our institution and to assess the sociodemographic factors contributing to it, and to predict the maximum risk period for still birth. Material and Methods: All patients who gave consent and delivered a baby either vaginally or by caeserian section after 28 weeks of gestation during the study period(july 2019-June 2020) were included in the study.Still Birth was defined as a baby born after 28 completed weeks of gestation or weighing more than 1 kg,with no signs of life .Total no of patients during the study period were 2629, with 5 sets of twins. So total no of birth during the study period was 2634. Epidemiological data were compared between still birth and total births.Causes of still births were analysed and period of maximum risk for still birth was predicted. Statistical Analysis :Descriptiveanalytes were expressed in proportion. Chi square test was used to assess the significance level and p value of <.05 was taken as significant. Result: Total no. of births by either vaginal route or caesarean section during june 2019 to july 2020 were 2634 foetuses. among which,137 fetus were still born. So still birth rate was 52/1000 live births.Maximum no of still births were in the age group of 20-25 years 69(50.3%), were primigravida 46(33.5%), belonged to low socioeconomic status 95(69.3%), came from rural areas79(57.6%) and were unbooked 94(68.6%).There was statistically significant difference(p=.0012) in unbooked cases when still births and total births were compared. No cause could be attributable to still birth in 15(10.9%) of cases, whereas 81(59.1%) had maternal causes,17(12.4%) had fetal causes, 19(13.8%) had placental causes while 5(3.6%) had other reasons like acute infections or thermal burns. Major reason of StillBirth amongst the maternal causes, was labour complications 38(37.7%), whereas intra uterine growth restriction was the leading cause 8(5.8%) amongst the fetal factors.36-40 week was the gestational age during which maximum still births occured.95(69.31%) of still birth cases were delivered by vaginal route Conclusion:Majority of still births were in unbooked cases and labourcomplications were the leading cause of still births overall. Hence antenatal care and delivery by skilled attendant is of paramount importance. Routine antenatal care would also lead to early recognition of maternal and fetal high risk factors and their management.

Magnitude and Determinants of Perinatal Mortality in Southwest Ethiopia

Despite several efforts globally, the problem of perinatal mortality remained an unsolved agenda. As a result, it continued to be an essential part of the third sustainable development goals to end preventable child deaths by 2030. With a rate of 33 per 1000 births, Ethiopia has the highest level of perinatal mortality in the world. Thus, determining the magnitude and identifying the determinants are very crucial for evidence-based interventions. A community-based longitudinal study was conducted in Southwest Ethiopia among 3474 pregnant women to estimate the magnitude of perinatal mortality. Then, a case-control study among 120 cases and 360 controls was conducted to identify the determinants of perinatal mortality. Data were collected by using an interviewer-administered questionnaire and analyzed by using SPSS version 20. Multivariate logistic regression analysis was used to identify variables having a significant association with perinatal mortality at p<0.05. The perinatal mortality rate was 34.5 (95% CI: 28.9, 41.1) deaths per 1000 births. Attending ≥4 ANC visits (AOR=0.46; 95% CI: 0.23, 0.91), having good knowledge on key danger signs (AOR=0.27; 95% CI: 0.10, 0.75), and having a skilled attendant at birth (AOR=0.34; 95% CI: 0.19, 0.61) were significantly associated with a reduction of perinatal mortality. Being a primipara (AOR=3.38; 95% CI: 1.90, 6.00), twin births (AOR=5.29; 95% CI: 1.46, 19.21), previous history of perinatal mortality (AOR=3.33; 95% CI: 1.27, 8.72), and obstetric complication during labor (AOR=4.27; 95% CI: 2.40, 7.59) significantly increased perinatal mortality. In conclusion, the magnitude of perinatal mortality in the study area was high as compared to the national target for 2020. Care during pregnancy and childbirth and conditions of pregnancy and labor were identified as determinants of perinatal mortality. Hence, interventions need to focus on increasing knowledge of danger signs and utilization of skilled maternity care. Special emphasis needs to be given to mothers with a previous history of perinatal mortality, twin pregnancies, and having obstetric complications.

Assessment of Quality of Antenatal Care Services and Its Determinant Factors in Public Health Facilities of Hossana Town, Hadiya Zone, Southern Ethiopia: A Longitudinal Study

Background. Antenatal care is a care that links the woman and her family with the formal health system, increases the chance of using a skilled attendant at birth, and contributes to good health through the life cycle. Inadequate care during this time breaks a critical link in the continuum of care and affects both women and babies. Therefore, the main aim of this study was to determine the quality of ANC in Hadiya Zone, Southern Ethiopia. Method. A longitudinal facility-based study design was conducted among 1123 mothers whose gestational age of less than 16 weeks was identified and followed until birth and 40 days after birth to detect whether they gained the acceptable standard of quality of ANC from July 2017 to June 2018. A structured, predefined, and pretested observation check list and Likert scales were employed to obtain the necessary information after getting both written and verbal consent from the concerned bodies and study participants. Data was entered into Epi Info version 3.5 and transferred to STATA Version 14 software and cleaned by reviewing frequency tables, logical errors, and checking outliers. Generalized estimating equation (GEE) analysis was applied to get the average response observation of each visit of quality of ANC in the health facilities. Result. This study showed that the overall magnitude of good quality of antenatal care service that was provided in the whole visit at Hosanna Town’s public health facilities was 1230 (31.38%). The most frequently identified problems were inability to take full history, lack of proper counseling, poor healthcare provider and client interaction, and improper registration and there was a variation in providing quality of care in each visit. Quality of antenatal care was significantly associated with residence, educational status gravidity, parity, and visit. In conclusion, the overall quality of antenatal care is low, so the health facilities need further modification on the identified problems.