Uptake of antenatal care services among women of reproductive age in Mandera County, Kenya

Background: Antenatal care is an opportunity for prevention and management of existing and potential causes of maternal and newborn mortality and morbidity. The new WHO antenatal care model, stipulates that, the first antenatal care visit takes place within the first trimester (gestational age of <12 weeks) and then, additional seven visits. Only 37% of women in Mandera County had utilized the recommended minimum four ANC visits. Objectives: There was need to assess the critical factors influencing the uptake of ANC in Mandera County Kenya, in order to enlighten stakeholders on the development of appropriate ANC Service Provision Program. This study took the intiative of bridging the gap. Methodology: The study adopted cross-sectional design using both quantitative and qualitative methods. Stratified and Sample random sampling were used to get a quantity of 348 respondents. Data was collected using questionnaire, FGDs and KIIs guides and Pearson's Chi-square test. Multivariate analysis using logistic regression was summarized to establish the strengths of the association. Odds Ratio (OR) and 95% Confidence Interval (CI) were used and threshold for statistical significance was set at p<0.05. Qualitative data was transcribed and analyzed thematically. Results: The proportion of women who utilized ANC was 83.0% and only 60.3% had attended recommended visits. Individual factors that influenced ANC uptake were; age, level of education, monthly income, gravida, parity and complications during pregnancy. Contextual factors that influenced ANC were; time taken to reach health facilities, source of maternal information and local discouragements. There was no significant relationship between Religion, marital status, age at first pregnancy with ANC uptake. Conclusion: The negative perception can change by; improving culturally sensitive ANC services accessibility by; increasing the number of female skilled health workers and reducing traveling time to the health facilities by conducting regular outreach services targeting villages with no close facility to pastoral communities. It will be important to strengthen CHVs' capacity to emphasize primary health care and accelerate progress towards UHC in the County. Provide health education and promotion targeting older mothers with high parity, women inclined to harmful cultural practices and their partners. In spite of a wide range of literature on ANC topics in most parts of Kenya, it was limited pertaining Mandera County. Recomandations: Meticulous understanding of local barriers and facilitating factors of ANC utilization is prerequisite for designing and implementing interventions that aim to improve ANC uptake. Well developed infrastructure is a basic need that falls in the category of basic wants for Mandera County

Factors associated with postpartum health problems among married women of reproductive age in the Democratic Republic of the Congo: a cross-sectional study in Kenge City

Maternal mortality is attracting attention worldwide, but maternal health problems after delivery have received less attention. Most studies focus on prenatal maternal health problems. We aimed to identify factors associated with postpartum health problems among married women of reproductive age in Democratic Republic of the Congo. We employed a cross-sectional study design and randomly enrolled 700 married women of reproductive age in Kenge city. Data collection instrument was developed using the UNICEF Multiple Indicator Cluster Survey. T-test, chi-square test, and binary logistic regression analysis were performed using the SPSS version 24.0. Significant risk factors associated with postpartum health problems were initial postnatal care period; within 24 hours (Odds Ratio [OR]=2.197, 95% confidence interval [CI]: [1.156­4.174], p=.016); within 7 days (OR=1.972, 95% CI: [1.102­3.528, p=.022]; within 14 days (OR=2.124, 95% CI: [1.082­4.172], p=.029) among reproductive health and health service utilization characteristics. Health education by RECO (Relais Cmunataure) was associated with postpartum health problems including PCIME (Prise en Charge Integree des Maladies de l'Enfant; OR=1.845, 95% CI: [1.038­3.282], p=.037); hand washing (OR=1.897, 95% CI: [1.060­3.396], p=.031); malaria (OR=2.003, 95% CI: [1.192­3.366], p=.009) among Maternal and Child Health intervention characteristics. In conclusion, it is necessary to develop and promote health policies and educational programs focusing on PNC service within 24 hours, PNC services within 7 days, PCIME, hand washing, prevention of malaria

Multi-drug resistant bacteria and associated factors among reproductive age women with significant bacteriuria

Background: Urinary tract infection (UTI), an infection that disproportionately affects women, is commonly caused by bacteria. Emergence of multi-drug resistant urinary tract infections is a serious health issue with significant maternal morbidity and mortality. Objective: The aim of this study was to assess the prevalence of multi-drug resistant bacteria and associated factors among reproductive age women with significant bacteriuria. Methods: Cross-sectional study was conducted from April to August 2016 on 424 study subjects in Jimma University Specialized Hospital. Data were collected using pretested questionnaire. Morning midstream urine samples were collected and processed following standard operating procedures. Antimicrobial susceptibility testing was done following Clinical Laboratory Standards Institute 2014 guidelines. Samples were tested for cell surface hydrophobicity, biofilm production, extended spectrum betalactamases and carbapenemases production. Results: The prevalence of UTI among suspected reproductive age women was 22.9%. E. coli was the most frequent isolate with a rate of 57% among isolated bacteria followed by Klebsiella species (24.7%). Over 90% of the isolates were multi-drug resistant. Resistance pattern for ampicillin was 100% followed by ticarcillin (92.4%) and colistin (86%) while less resistance rate was found for imipenem(13%). Multivariate analysis revealed that risk factors such as previous history of hospitalization, extended spectrum betalactamase production and strong biofilm production were significantly associated with multidrug resistance (p <0.05). Conclusion: The prevalence of multi-drug resistance (MDR) among isolates of UTI in the study was high and this correlates with the prevalence of virulence phenotypes. Gram-negative organisms were the most common causes of UTIs

Covert contraceptive use among women of reproductive age in Ibadan, Nigeria

BACKGROUND: This study assessed the prevalence and determinants of covert contraceptive use among women of reproductive age in Ibadan, Nigeria. METHODS: A cross sectional study among women attending a family planning clinic in a maternity teaching hospital in Ibadan, Nigeria was conducted. Data was collected on sociodemographic characteristics, contraceptive use and partner awareness of use. The socio-demographic predictors of covert contraceptive use were explored using logistic regressions. RESULTS: Twenty-five (6.8%) of the 365 respondents were practicing covert contraception. Their mean age was 34.7+6.67 years, 98.6% were married and with modal parity of 3 (29.6%). A logistic regression analysis showed that participants' age (p = 0.555), occupation (p = 0.679), education (p = 0.642), parity (p = 0.385) and husbands' education (p = 0.926) were not statistically associated with covert contraceptive use while husbands' financial supports (p = 0.000) and approval for family planning use (p = 0.000) were associated with reduction in the likelihood covert contraceptive use. CONCLUSION: Covert contraceptive use exist among our women. Poor financial support and disapproval by the husbands were the strongest predictors of the practice. Greater male involvement in contraceptive service provision will help address these negative factors promoting covert contraceptive practices

Effect of Vitamin A Supplementation on Cause-Specific Mortality in Women of Reproductive Age in Ghana: a Secondary Analysis from the ObaapaVitA trial

Objective:To determine the effect of weekly low-dose vitamin A supplementation on cause-specific mortality in women of reproductive age in Ghana. Methods: A cluster-randomized; triple-blind; placebo-controlled trial was conducted in seven districts of the Brong Ahafo region of Ghana. Women aged 15-45 years who were capable of giving informed consent and intended to live in the trial area for at least 3 months were enrolled and randomly assigned; according to their cluster of residence; to receive oral vitamin A (7500 ?g) or placebo once a week. Randomization was blocked; with two clusters in each fieldwork area allocated to vitamin A and two to placebo. Every 4 weeks; fieldworkers distributed capsules and collected data during home visits. Verbal autopsies were conducted by field supervisors and reviewed by physicians; who assigned a cause of death. Cause-specific mortality rates in both arms were compared by means of random-effects Poisson regression models to allow for the cluster randomization. Analysis was by intention-to-treat; based on cluster of residence; with women eligible for inclusion once they had consistently received the supplement or placebo capsules for 6 months. Findings The analysis was based on 581 870 woman-years and 2624 deaths. Cause-specific mortality rates were found to be similar in the two study arms.Conclusion: Low-dose vitamin A supplements administered weekly are of no benefit in programmes to reduce mortality in women of childbearing age