Acceptability and User Experiences of a Patient-Held Smart Card for Antenatal Services in Nigeria: A Qualitative Study

Background Poor maternal, newborn and child health outcomes remain a major public health challenge in Nigeria. Mobile health (mHealth) interventions such as patient-held smart cards have been proposed as effective solutions to improve maternal health outcomes. Our objectives were to assess the acceptability and experiences of pregnant women with the use of a patient-held smartcard for antenatal services in Nigeria. Methods Using focus group discussions, qualitative data were obtained from 35 pregnant women attending antenatal services in four Local Government Areas (LGAs) in Benue State, Nigeria. The audio-recorded data were transcribed and analyzed using framework analysis techniques such as the PEN-3 cultural model as a guide. Results The participants were 18-44 years of age (median age: 24 years), all were married and the majority were farmers. Most of the participants had accepted and used the smartcards for antenatal services. The most common positive perceptions about the smartcards were their ability to be used across multiple health facilities, the preference for storage of the women’s medical information on the smartcards compared to the usual paper-based system, and shorter waiting times at the clinics. Notable facilitators to using the smartcards were its provision at the “Baby showers” which were already acceptable to the women, access to free medical screenings, and ease of storage and retrieval of health records from the cards. Costs associated with health services was reported as a major barrier to using the smartcards. Support from health workers, program staff and family members, particularly spouses, encouraged the participants to use the smartcards. Conclusion These findings revealed that patient-held smart card for maternal health care services is acceptable by women utilizing antenatal services in Nigeria. Understanding perceptions, barriers, facilitators, and supportive systems that enhance the use of these smart cards may facilitate the development of lifesaving mobile health platforms that have the potential to achieve antenatal, delivery, and postnatal targets in a resource-limited setting.

Pregnant Women's Perception of the Effectiveness, Safety and Timeliness of Antenatal Services Provided by Midwives in Government-Owned Healthcare Facilities in South-South Nigeria

Background: Both non- and under-utilization of antenatal services can lead to poor materno-fetal outcomes. Perception of the effectiveness, safety and timeliness of the services by pregnant women may substantially affect the utilization. Objectives: The objectives of this study were to determine pregnant women’s perception of the effectiveness, safety and timeliness of the antenatal services provided by midwives, and the relationships between effectiveness, safety and timeliness of antenatal services at government-owned healthcare facilities in South-South Nigeria. Method: A cross-sectional research design was adopted for the study. Multistage sampling technique was used to select 30 primary, secondary and tertiary government-owned health facilities across the six States in South-South Nigeria from which 50 respondents were selected from each of the selected facilities. A total of 1,500 pregnant women were selected for the study. The instrument used for data collection was a self-developed Questionnaire on Pregnant Women’s Perception of the Effectiveness, Safety and Timeliness of Antenatal Services Provided by Midwives. The reliability of the instrument was established through the test-retest method using Cronbach’s alpha which yielded co-efficient of 0.715. Data collected were analyzed using frequencies, percentages, mean and Spearman Rank order correlation. Results: The result showed means of 4.27+0.68, 3.72+1.03, 3.23+1.17 respectively for pregnant women’s perceived effectiveness, safety and timeliness of antenatal services provided by midwives. Significant relationships also existed between safety and effectiveness (rho = 0.33, p < 0.001), as well as between timeliness and effectiveness (rho = 0.10, p < 0.001) of the antenatal services. Conclusion: Pregnant women in South-South Nigeria had a positive perception of effectiveness, safety and timeliness of the antenatal services provided by midwives. Midwives in government-owned healthcare facilities should conduct regular evaluations to get feedback from pregnant women regarding the quality of antenatal services they provide.

Association between maternal antenatal care visits and newborn low birth weight in Bangladesh: a national representative survey

Background: Low Birth Weight (LBW) is a global health concern for childhood mortality and morbidity. The objectives of this study were to assess the association between the number of Antenatal Care Visits (ANC) and LBW among Bangladeshi newborns, and to identify the demographic and socio-economic predictors of LBW. Methods: Our present cross-sectional study is based on the secondary data of the Bangladesh Demography and Health Survey (BDHS) 2014. Complete data of 4,235 (weighted) mother-child pairs were included in the analysis. Results: The overall prevalence of LBW among newborns were found to be 19.3% (95% CI: 17.8-20.9). Among the mothers who received antenatal care services 1-3 times during pregnancy, 35% had less possibility of having LBW babies [COR = 0.65, 95% CI: 0.50-0.85]. The association remained significant after adjusting the analysis with the sex of the newborn, administrative regions (division), maternal educational status, mother’s weight status and fathers’ occupation [AOR = 0.74, 95% CI: 0.55-0.99]. Additionally, the sex of the newborn, division, maternal education, maternal weight status, and fathers’ occupational status were found to be significantly associated with LBW. Conclusion: Increasing the coverage of antenatal services and enabling mothers to receive quality antenatal services may substantially contribute to reducing the prevalence of LBW in Bangladesh.

THE QUALITY OF ANTENATAL CARE BASED ON INDEX SATISFACTION OF PREGNANT WOMEN

Background: Quality antenatal care in the MCH program is considered to be one of the effective efforts to reduce maternal and child morbidity and mortality. An indicator of the success of ANC services can be seen from the output produced, namely in the form of K4 coverage. According to Kotler there are 5 (five) determinants of service quality that can be used as a basis for assessing the level of customer satisfaction with the quality of service received including Tangibles, Reliability, Responsiveness, Assurance and Empathy. Method: This research method is quantitative descriptive with survey approach. The total sample of 149 pregnant women with total sampling techniques. The instrument used was a questionnaire. Data analysis uses univariate analysis. Results: The most valued statements both from each dimension namely; tangible: Midwife performance reliability: recording in the MCH handbook, responsiveness: responses to complaints, assurance: the nature of the Midwife, empathy of communication between midwives and patients. The most valued statements are enough from each dimension namely; tangible: examination room, reliability: service procedures, responsieness: midwife response to patients waiting for long queues, assurance: guarantee to service, empathy: suitability of waiting time and duration of service. Conclusion: The data shows that the majority of respondents considered the quality of antenatal services at the Tambakrejo Public Health Center to be good but still needed to be improved so that the assessment was sufficiently good.

A mixed reception: perceptions of pregnant adolescents’ experiences with health care workers in Cape Town, South Africa

Background Maternal mortality among adolescent mothers in South Africa is higher than many middle-income countries. This is largely attributable to conditions that can be prevented or managed by high quality antenatal care. The way in which pregnant adolescents are treated at antenatal clinics influences their timely utilization of antenatal services. This qualitative study reports on the experiences of pregnant adolescents with health care workers when accessing antenatal care. Methods Pregnant girls aged 13–19 (n = 19) who attended public health care facilities that provide Basic Antenatal Care (BANC) services in Cape Town, South Africa were recruited. Four face to face in-depth interviews and four mini focus group discussions were undertaken, facilitated by a topic guide. Thematic analyses were used to analyse the data. Results Experiences that reinforce antenatal attendance, such as respectful and supportive treatment, were outweighed by negative experiences, such as victimization; discrimination against being pregnant at a young age; experiencing disregard and exclusion; inadequate provision of information about pregnancy, health and childbirth; clinic attendance discouragement; and mental health turmoil. Conclusions There is evidence of a discordant relationship between the health care workers and the pregnant adolescents. Adolescents feel mistreated and discriminated against by the health care workers, which in turn discourages their attendance at antenatal clinics. Maternal health care workers need to receive support and regular training on the provision of youth friendly antenatal care and be regularly evaluated, to promote the provision of fair and high quality antenatal services for adolescent girls.

Knowledge and preventive practices towards COVID-19 among pregnant women seeking antenatal services in Northern Ghana

Background COVID-19 is a novel respiratory disease associated with severe morbidity and high mortality in the elderly population and people with comorbidities. Studies have suggested that pregnant women are more susceptible to COVID-19 compared to non-pregnant women. However, it’s unclear whether pregnant women in Ghana are knowledgeable about COVID-19 and practice preventive measures against it. This study sought to assess the knowledge and preventive practices towards COVID-19 among pregnant women seeking antenatal services in Northern Ghana. Methods A cross-sectional study was conducted using a structured questionnaire in the Nabdam district in Ghana. A total of 527 pregnant women were randomly sampled from health facilities offering antenatal care services in the district. Multivariable logistic regression analysis was used to assess the association between the predictors and outcome variables. Results The prevalence of adequate knowledge and good COVID-19 preventive practices were 85.6%, (95% CI: 82.57, 88.59) and 46.6%, (95% CI: 42.41, 50.95) respectively. Having at least a primary education, residing in an urban area, and receiving COVID-19 education at a health facility were positively associated with adequate knowledge on COVID-19. Factors positively associated with good COVID-19 preventive practices were older age, having at least a primary education, pregnant women with a chronic disease, and living in an urban area. Multiparity was negatively associated with good COVID-19 preventive practices. Conclusion Although majority of women had adequate knowledge of COVID-19, less than half of them were engaged in good COVID-19 preventive practices. Education of pregnant women on COVID-19 preventive practices should be intensified at health facilities while improving upon the water, sanitation and hygiene need particularly in rural communities.

Demographic characteristics, medical needs and utilisation of antenatal care among pregnant undocumented migrants living in Denmark between 2011 and 2017

Introduction: An estimated 22,900–28,900 individuals live undocumented in Denmark, of whom many are women of reproductive age. Undocumented migrants in Denmark who are pregnant only have legal rights to health care in emergencies, which may lead to under-utilisation of antenatal care, despite the possibility of these women seeking antenatal care through informal networks. This study aimed to describe the demographics, general medical needs and prevalence of induced abortions among pregnant undocumented migrant women. Further, we aimed to investigate if the women received antenatal services as recommended, focusing on the timing of their first entry to antenatal care and the number of antenatal visits. Methods: This was a retrospective cross-sectional study. We used data from medical records at a health clinic managed by non-governmental organisations (NGOs) in Denmark from 1 January 2011 to 31 December 2017. Data regarding 679 pregnant women were included in descriptive and regression analyses. Results: The women had a mean age of 28.7 years, originated from 78 different countries and had diverse migration backgrounds. Among the 679 included women, there were 119 pregnancy-related complications. Regarding the utilisation of antenatal services, 52.6% had a late first attendance to antenatal care, and the likelihood of a late first attendance was highest among 35- to 44-year-olds. The majority (92.6%) of the women did not have the recommended number of antenatal care visits, and this was evident across all regions of origin. Logistic regression showed variation in utilisation of antenatal services according to age and region of origin. Conclusions: A quarter of the study population attended the health clinic requesting pregnancy termination. The pregnant undocumented migrants had few medical complications and predominantly attended the health clinic for antenatal care. However, some did attend the clinic with general or pregnancy-related medical conditions. Almost half of the study population had a late first attendance to antenatal care, and the vast majority did not have the recommended number of antenatal care visits. These results call for consideration as to whether health care for pregnant undocumented migrants should be formally available and free of charge.

OVERVIEW OF PREGNANT WOMAN BEHAVIOUR AGAINST ANTENATAL CARE COMPLIANCE IN KEBON KALAPA VILLAGE, CISARUA SUB-DISTRICT, SUMEDANG REGENCY, WEST JAVA IN 2019

Antenatal services, according to standards, are services provided to pregnant women, given four times during pregnancy. According to RISKESDAS Data, the province's antenatal care proportion in Indonesia was 2013 at 95.2% and 2018 at 96.1% over the past five years. This study was designed to describe pregnant women against antenatal mediation in Kebon Kalapa Village, Cisarua District, Sumedang, West Java, 2019. This research is a descriptive-analytic study. Sampling using purposive sampling technique and obtained a total sample of 22 respondents. The results showed significant differences between pregnant women's knowledge, attitudes, and practices about the regulation of antenatal care in Kebon Kalapa Village, Cisarua District, Sumedang, West Java, in 2019. The research studies showed that there was a significant difference between knowledge, attitudes and antenatal care practices in Kebon Kalapa Village, Cisarua District, Sumedang, West Java, 2019 with an overview of good knowledge is nine people (40.9%) and sufficient knowledge of 4 people (18.2%). An overview of a good attitude is 21 people (95.5%), and an overview of good practice is 17 people (77.3%). The overview of antenatal care is 18 people (81.8%). Most pregnant women in Kebon Kalapa Village, Cisarua District, Sumedang Regency, West Java In 2019 have good knowledge, and most pregnant women in Kebon Kalapa Village, Cisarua District, Sumedang District, West Java, 2019 have a positive attitude. Most pregnant women in Kebon Kalapa Village Cisarua Sumedang Regency, West Java 2019 have positive practice, and most pregnant women in Kebon Kalapa Village, Cisarua Sub-District, Sumedang District, West Java, 2019 are obedient to antenatal care.

Analysis of Antenatal Care by Maternal to Health Services Utilization in Working Area of Cot Girek Health Centre

According to Minister of Health Regulation (Permenkes) No. 43 of 2016 every maternal must get antenatal services according to the standard which provided to pregnant women at least 4 times during pregnancy with a schedule of one first trimester, one second trimester and two-third trimesters. The purpose of this study was to determine and analyze the influence of knowledge, attitudes, education, parity, income, support of health workers, a distance of health services and maternal health to the utilization of health services in the working area of the Cot Girek health centre, a population of this study amounted 512 people and 83 respondents were taken as the sample of this study. The research was Quantitative research used Mixed Method. The results showed of knowledge p = 0.000, education p = 0.000, income p = 0.000, support of health workers p = 0.000 shows a relationship to the utilization of health services. While attitudes p = .609, parity p = .823, distance of health services p = .167, maternal health p = .386 showed no relationship to the utilization of health services. The conclusion in this study is the influence of knowledge, education, income and support of health workers on the utilization of health services found, while the attitudes, parity, distance of health services and maternal health have no found about relationship to the utilization of health services. This research can be used as information for health workers to be more active in promoting antenatal care programs.