Influence of short message service reminders on utilisation of focused antenatal care among women in rural Kenya: a randomised controlled trial

Background/aims The short message service is a part of mobile health, which is defined as medical and public health practices that are supported by mobile devices, such as mobile phones, personal digital assistants, and other wireless devices. Mobile health has documented positive outcomes on other health services, including focused antenatal care. The focused antenatal care model emphasises quality of care rather than quantity of antenatal visits, and the World Health Organization recommends a minimum of four targeted antenatal visits. This study examines the influence of short message service reminders on utilisation of focused antenatal care in rural Kenya. Methods This was a randomised controlled trial with 118 respondents in each of two study arms, intervention and control, conducted in Tharaka Nithi, Kenya. The study group were pregnant women attending their first antenatal care visit in Tharaka sub-county health facilities. The intervention was three short message service reminders a week before the scheduled visit. Structured questionnaires were used to collect baseline and exit interviews. The chi-square test and logistic regression were used to check associations between uptake of antenatal care and participant characteristics at 5% significance level. Results Three quarters (75%) of the respondents in the intervention group completed the four targeted antenatal visits, whereas only 10% of respondents attended the required four visits in the control group. None of the sociodemographic variables were found to have any association or influence on focused antenatal care attendance. Short message reminders increased the chances of attending the recommended visits by 27 times (P<0.001). Conclusions Short message service reminders have a positive influence on utilisation of focused antenatal care. This research paper recommends that policymakers and health managers use short message service reminders to increase the uptake of focused antenatal care.

DETERMINANTS OF FOCUSED ANTENATAL CARE USE AMONG PREGNANT WOMEN, ATTENDING DELIVERY, IN KARAMARA HOSPITAL, JIGJIGA TOWN, SOMALI REGION, EAST ETHIOPIA

Objective: The aim of the study was to assess the determinants of focused antenatal care (ANC) use among pregnant women attending delivery in Karamara Hospital at Jigjiga town, Somali region, East Ethiopia from February to March 2017. Methods: Unmatched case–control study was conduct in Karamara hospital at Jigjiga town. A total of 366 women 183 cases and 183 controls were selected by convenience sampling techniques. Data were collected by trained data collectors using face-to-face interview of women. Logistic regression model was used to determine the predictors of focused ANC nonuse. Variables with p<0.05 and 95% confidence interval were considered as statistically significant. Results: The study revealed that 80.3% of women had ANC follow-up in their last pregnancy. About 39.3% of women had FANC visit. Urban resident women (AOR=3.1, 95% CI [1.418, 7.211]), knowledge of danger signs of pregnancy (AOR=3.5, 95% CI [1.886, 6.832]), knowledge of days FANC services provision (AOR=4.4, 95% CI [1.86, 10.59]), existence of tradition believe about FANC (AOR=0.16, 95% CI [0.079, 0.347]), distance less than or equal 1 h (AOR=2.2, 95% CI [0.838, 5.850]), existence of health facility (AOR=3.14, 95% CI [1.38, 7.544]), information form health-care provider (AOR=3.6, 95% CI [1.04, 12.83]) delivery than their counterpart, and payment needed to use FANC (AOR=0.138, 95% CI [0.057, 0.331]) were significantly associated with FANC use. Conclusion: Being urban resident, knowledge about danger sign of pregnancy, time to reach nearest health facility, radio/Tv use and culture were significantly associated with FANC utilization among pregnant women. Thus, efforts should be made to improve accessibility and availability of the health facility, educating of pregnant women about danger signs of pregnancy physical, information education, and communication of the benefits of FANC service were also critical area that needs intervention.

Nutrition counselling and knowledge on iron and folic acid supplementation among pregnant women in Nyeri County, Kenya

Background: In the world, a deficiency of iron is the most common nutrition disorder affecting more than 30% of the global populace more so children and women. Countries in the developing world are working in programs on implementing the iron and folic acid supplementation (IFAS) although the effectiveness of curbing anemia is usually affected by non-compliance to iron and folic acid supplements by women who are pregnant. The government of Kenya has come up with strategies to deal with anemia which include supplementation of iron and folic acid, implementation of focused antenatal care even though they have encountered a few hurdles resulting to sub optimal coverage and low levels of compliance.Methods: This was a mixed method study whereby both qualitative and quantitative data was analysed. A sample size of 385 pregnant women were interviewed. Data was collected using questionnaires. Descriptive statistics were used to analyze the quantitative data which was presented in form of frequency and percentage tables, bar graphs and pie charts. Results: Results show that 96% of the expectant women indicated that they were advised to take fruits while 86% indicated that they were advised to take green vegetables. This shows that pregnant women in the study had good knowledge of their dietary needs.Conclusions: The study concludes that expectant women had high nutrition knowledge on foods that raise the haemoglobin levels during gravidity.

Respectful focused antenatal care and associated factors among pregnant women who visit Shashemene town public hospitals, Oromia region, Ethiopia: a cross‐sectional study

Background Focused antenatal care is the most significant and inclusive care given to pregnant women to promote and maintain the optimal health of the mother and the fetus. Providing respectful care during focused antenatal care is believed to be the most important cost-effective interventions to increase maternity service utilization. Therefore, this study was aimed to assess respectful focused antenatal care and associated factors among pregnant women who visit Shashemene town public hospitals, Oromia region, Ethiopia, 2019. Methods Institution-based cross-sectional study was conducted from July-August, 2019. A total of 423 pregnant mothers were selected using a systematic sampling technique. Data were collected using structured and pre-tested interviewer-administered questionnaires. Data entry and analysis were made using Epi Info version™ 7 and Statistical Package for Social Science (SPSS) version 24.0 respectively. Both bivariate and multivariate logistic regression analyses were used to identify associated factors. Statistical significance was declared at a p value of < 0.05 with a 95% confidence level. Results A total of 420 women have participated in the study, making a response rate of 99.5%. About 63% of participants received respectful care during focused antenatal care. Having no formal education [AOR = 8.3(95%CI 9.85–17.47)], low average monthly income [AOR = 3.16 (95%CI 1.52–6.57)], having unplanned pregnancy [AOR = 9.90 (95%CI 3.48–8.16)] and being multigravida [AOR = 8.82 (95%CI 2.90–6.80)] were significantly associated with respectful focused antenatal care. Conclusions The study findings indicate that respondents’ respectful focused antenatal care is mainly affected by educational level, average family monthly income, having an unplanned pregnancy, and gravidity. Providing acceptable, quality, and honorable care for all women regardless of educational status, family income, and status of pregnancy is very crucial to entice more mothers to the health facility.

Intervention fidelity and its determinants of focused antenatal care package implementation, in south Wollo zone, Northeast Ethiopia

Background Focused antenatal care is directed at sustaining maternal health and improving fetal wellbeing to ensure birth of a healthy neonate. Failure to implement focused antenatal care can result in inability to reduce maternal and perinatal morbidity and mortality in low income countries. Due to evidence-practice gaps, however, thousands of maternal, fetal and neonatal lives are still lost every day, mostly from preventable causes. This study aimed to assess focused antenatal care package’s intervention fidelity and its determinant factors in South Wollo Zone, Northeast Ethiopia. Methods A cross-sectional study design was employed and a total of 898 women who gave birth in the last 6 months prior to data collection were included. Also 16 health extension workers, working in ten selected health posts, were included. Interviews and self-administered questionnaires were used to collect data from mothers and health extension workers. Ten [10] health posts were audited to assess availability and functionality of drugs and supplies to provide focused antenatal care. Mothers were asked whether or not the required level of care was provided. Health extension workers were provided with self-administered questionnaires to assess socio-demographic characteristics, reception of training, facilitation strategies for the implementation of focused antenatal care and ability to classify danger signs. Multilevel linear regression analysis was performed to identify individual and organizational level’s factors influencing focused antenatal care package intervention fidelity. Results Overall weighted average focused antenatal care package intervention fidelity (implemented as intended/planned) was 49.8% (95% CI: 47.7–51.8), which means the average number of focused antenatal care package interventions women received is 49.8%. Health extension workers implemented 55.1% and skilled providers (nurses, midwives, health officers or medical doctors) 44.9% of focused antenatal care package interventions. Overall antenatal care coverage, irrespective of frequency (at least one visit), was 752/898 women (83.7%; 95% CI: 81.3–86.1); 263/752 women (35.0%; 95% CI: 31.6–38.4) received at least four antenatal visits and only 46/752 women (6.1%; 95% CI: 4.4–7.8) received all recommended components of focused antenatal care. Previous pregnancy-related problems, paternal education and implementation of facilitation strategies were found to be significant factors enhancing focused antenatal care package intervention fidelity. Conclusion Focused antenatal care package intervention fidelity in the study area was low; this may imply that the current level of maternal, perinatal and neonatal mortality might be partly due to the low level of focused antenatal care intervention fidelity. Improving implementation of facilitation strategies is highly required to contribute to the reduction of those mortalities.

Intervention fidelity and its determinants of focused antenatal care package implementation, in South Wollo, Northeast Ethiopia.

Background: Focused antenatal care is directed at sustaining maternal health and improving fetal wellbeing to ensure birth of a healthy neonate. Failure to implement focused antenatal care can result in inability to reduce maternal and perinatal morbidity and mortality in low income countries. Due to evidence-practice gaps, however, thousands of maternal, fetal and neonatal lives are still lost every day, mostly from preventable causes. This study aimed to assess focused antenatal care package’s intervention fidelity and its determinant factors in South Wollo Zone, Northeast Ethiopia. Methods: A cross-sectional study design was employed and a total of 898 women who gave birth in the last six months prior to data collection were included. Also 16 health extension workers, working in ten selected health posts, were included. Interviews and self-administered questionnaires were used to collect data from mothers and health extension workers. Ten (10) health posts were audited to assess availability and functionality of drugs and supplies to provide focused antenatal care. Mothers were asked whether or not the required level of care was provided. Health extension workers were provided with self-administered questionnaires to assess socio-demographic characteristics, reception of training, facilitation strategies for the implementation of focused antenatal care and ability to classify danger signs. Multilevel linear regression analysis was performed to identify individual and organizational level’s factors influencing focused antenatal care package intervention fidelity. Results: Overall weighted average focused antenatal care package intervention fidelity (implemented as intended/planned) was 49.8% (95% CI: 47.7 – 51.8), which means the average number of focused antenatal care package interventions women received is 49.8%. Health extension workers implemented 55.1% and skilled providers (nurses, midwives, health officers or medical doctors) 44.9% of focused antenatal care package interventions. Overall antenatal care coverage, irrespective of frequency (at least one visit), was 752/898 women (83.7%; 95% CI: 81.3–86.1); 263/752 women (35.0%; 95% CI: 31.6 – 38.4) received at least four antenatal visits and only 46/752 women (6.1%; 95% CI: 4.4 - 7.8) received all recommended components of focused antenatal care. Previous pregnancy-related problems, paternal education and implementation of facilitation strategies were found to be significant factors enhancing focused antenatal care package intervention fidelity.Conclusion: Focused antenatal care package intervention fidelity in the study area was low; this may imply that the current level of maternal, perinatal and neonatal mortality might be partly due to the low level of focused antenatal care intervention fidelity. Improving implementation of facilitation strategies is highly required to contribute to the reduction of those mortalities.

Intervention fidelity and its determinants of focused antenatal care package implementation, in South Wollo Zone, Northeast Ethiopia.

Background: Focused antenatal care activities are directed at sustaining maternal health and improving fetal wellbeing to ensure birth of a live healthy neonate. Failure to implement focused antenatal care can result in inability to reduce maternal and perinatal morbidity and mortality in low income countries. Due to evidence-practice gaps, however, thousands of maternal, fetal and neonatal lives are still lost every day, mostly from preventable causes. This study aimed to assess focused antenatal care package’s intervention fidelity and its determinant factors in South Wollo Zone, Northeast Ethiopia. Methods: A cross-sectional study design was employed and a total of 898 women who gave birth in the last six months prior to data collection were included. Also 16 health extension workers, working in ten selected health posts, were included. Interviews and self-administered questionnaires were used to collect data from mothers and health extension workers. Ten (10) Health posts were audited to assess availability and functionality of drugs and supplies to provide focused antenatal care. Mothers were asked whether or not the required level of care was provided. Health extension workers were provided with self-administered questionnaires to assess socio-demographic characteristics, reception of training, facilitation strategies for the implementation of focused antenatal care and ability to classify danger signs. Multilevel linear regression analysis was performed to identify individual and organizational level’s factors influencing focused antenatal care package intervention fidelity. Results: Overall weighted average focused antenatal care package intervention fidelity (implemented as intended/planned) was 49.8% (95% CI: 47.7 – 51.8), which means the average number of focused antenatal care package interventions a mother received is 49.8%. Health extension workers implemented 55.1% and skilled providers (nurses, midwives, health officers or medical doctors) 44.9% of focused antenatal care package intervention. Overall antenatal care coverage, irrespective of frequency (at least one visit), was 752 women (83.7%; 95% CI: 81.3–86.1); 263 women (35.0%; 95% CI: 31.6 – 38.4) received at least four antenatal visits and 46 women (6.1%; 95% CI: 4.4 - 7.8) received all recommended components of focused antenatal care. Previous pregnancy-related problems, paternal education and implementation of facilitation strategies were found to be significant factors enhancing focused antenatal care package intervention fidelity.Conclusion: Focused antenatal care package intervention fidelity in the study area was low; this may imply that the current level of maternal, perinatal and neonatal mortality might be partly due to the low level of focused antenatal care intervention fidelity. Improving implementation of facilitation strategies is highly required to contribute to the reduction of those mortalities.

Sociodemographic factors associated with postnatal maternal complications in public hospitals in Nairobi City County, Kenya

Introduction/Aims Focused antenatal care provides individualised counselling, targeted assessment and safe, cost effective, evidence-based intervention. It has been implemented in developing countries as a strategy to improve maternal health. This study aimed to investigate sociodemographic factors associated with maternal complications in selected public county hospitals in Nairobi City County, Kenya. Methods This was a cross-sectional study using a sample of 397 postnatal women who were given a questionnaire, with sections on their sociodemographic and health characteristics. Data analysis was done using the Chi Square test to determine the association between study variables, with P<0.05 considered statistically significant. Results The study found that 30% of respondents reported a maternal complication during their current delivery outcome. Sociodemographic factors significantly associated with maternal complications were age (P=0.002), occupation (P=0.001) and income (P=0.011). The health factors associated with occurrence of maternal complications were number of deliveries (P=0.001) and mode of delivery (P=0.001). Conclusions A number of factors were found to be significantly associated with maternal outcomes, including age and occupation. Further studies to determine why young women do not use focused antenatal care are necessary, as this would help reduce the incidence of birth-associated complications.