Determinants of anemia among pregnant women attending a tertiary hospital, Mogadishu, Somalia: unmatched case-control study

SUMMARY OBJECTIVE: The objective of this study was to identify the factors associated with anemia among pregnant women attending a tertiary referral hospital in Mogadishu, Somalia. METHODS: An unmatched case-control study was conducted on pregnant women who visited the antenatal clinics of a tertiary referral hospital between March and July 2021. The study recruited pregnant women who had a hemoglobin level of <11 g/dL into the anemic group, while those with hemoglobin levels ≥11 g/dL were included in the non-anemic group. Demographics, clinical, obstetrics, nutrition-related, hygiene- and sanitation-related, and parasitic infection-related data were collected. RESULTS: A total of 449 pregnant women (399 anemic and 50 non-anemic) participated in the study. A total of 224 (56.7%) in the anemic group and 31 (62.0%) in the non-anemic group did not consume any dark green, leafy vegetables such as spinach, bukurey, cagaar, and koomboow (p=0.040). Notably, 255 (63.9%) in the anemic group and 21 (42.0%) in the non-anemic group had a middle-upper arm circumference <23 cm. More than half of anemic [335 (84%)] and non-anemic [46 (92.0%)] were classified under low dietary diversity score. Majority of the study participants, 288 (72.4%) of the anemic and 39 (78%) of the non-anemic groups, used pit toilets in dwellings, and 70.2% (134/191) of the anemic and 64.4% (246/382) of the non-anemic groups disposed of solid waste in open fields. CONCLUSION: This study demonstrated that women who consumed green vegetables such as spinach, bukurey, cagaar, and koomboow in their diet had middle-upper arm circumference less than 23 cm, and those with low dietary diversity significantly developed anemia during pregnancy.

Improving breastfeeding among adolescent mothers: a prospective cohort

ABSTRACT BACKGROUND: Exclusive breastfeeding is recommended for the first six months, and mother's age impact early weaning. Educational support and relevant information can increase breastfeeding rates. OBJECTIVE: To determine whether antenatal education enhances the maintenance, intention, and confidence in breastfeeding among adolescents. DESIGN AND SETTING: A prospective cohort study involving primiparous adolescents who gave birth at the Woman's Hospital (CAISM), Universidade Estadual de Campinas, Brazil. METHODS: Adolescent mothers were categorized into two groups based on the location of prenatal care: those at the Woman's Hospital (WH) who received antenatal education, and at the Primary Care (PC) who did not receive antenatal education. All adolescents received breastfeeding orientation during their postpartum hospital stay. The groups were compared using the Student's t-test, Mann-Whitney U test, and chi-squared test. Log-binomial models were used to compare the groups at different time intervals. RESULTS: The study included 132 adolescents: 59 in the WH group and 73 in the PC group. Six months postpartum, adolescents in the WH group demonstrated higher engagement in breastfeeding (P < 0.005) and exclusive breastfeeding (P = 0.04) than PC group. PC group showed greater lack of confidence in breastfeeding (P = 0.02) and felt less prepared (P = 0.01). Notably, all WH adolescents reported a stronger desire to breastfeed after antenatal education. CONCLUSION: Antenatal education significantly improves the maintenance, intention, and confidence of breastfeeding among adolescents. This education approach can be implemented across all healthcare levels and should be made accessible to all women throughout the pregnancy and postpartum period.

A Case of Childhood-Onset Bartter Syndrome Type 1 with Renal Dysfunction / 罕见病研究

Bartter syndrome (BS, OMIM #601678) is a rare inherited salt-losing tubulopathy characterized by hypokalemia metabolic alkalosis with secondary renin-angiotensin-aldosterone system activation. As reported, BS type 1 is generally presented prenatal and neonatal period, and symptoms usually appear before and after birth or in infancy, accompanied by severe salt loss, whilst kidney function remains mostly normal. In this study, we report a case of BS type 1 with childhood onset and proteinuria and renal impairment. The child was born preterm due to hyperamniotic fluid, but there were no apparent symptoms after birth until the age of 3 when the child began to present with polydipsia, polyuria and increased nocturnal uria. At the age of 5, she had elevated serum creatinine level and proteinuria. After admission, she was diagnosed with chronic tubulointerstitial disease and stage 2 chronic kidney disease(CKD). According to the chloride clearance test, the abnormal function of medullary thick ascending limb Henle′s loop, was confirmed and BS type 1 was diagnosed by gene sequencing. After active management of complications, kidney function of the child improved. In the long-term follow-up, the urinary protein amount of the child still increased, eGFR slowly decreased, and the child was currently in the CKD2 stage. Children with prenatal BS may not present typical clinical manifestations immediately after birth until the onset of relevant clinical symptoms in childhood. BS type 1 patients may have renal impairment, which needs to be identified in time. Clinical differentiation diagnosis between BS and Gitelman syndrome can be made by chloride clearance tests. Early diagnosis and treatment are critical to improve prognosis.

Costo-efectividad de la calidad del control prenatal con respecto al bajo peso al nacer en el Cauca / Antenatal control quality cost-effectiveness regarding low birth weight in Cauca

Antecedentes: El departamento del Cauca en Colombia es multiétnico, multicultural y biodiverso, también con grandes diferencias en bajo peso al nacer (BPN), mortalidad perinatal y mortalidad neonatal tardía entre municipios. Objetivo: Determinar la relación de costo-efectividad del control prenatal (CPN) cuando ha tenido buena calidad frente al que ha tenido calidad deficiente con respecto al BPN en el departamento del Cauca entre 2018 y 2020. Método: Evaluación económica con diseño epidemiológico de una cohorte histórica desde la perspectiva de la institución pagadora. Se calculó la razón incremental de costo-efectividad (RICE), análisis de sensibilidad e impacto presupuestal. Resultados: La incidencia de BPN fue del 8,3% (348/4182). La calidad deficiente en el CPN incrementó el riesgo de BPN (OR: 3,38; IC95%: 1,05-8,2) y la buena calidad tuvo una mejor relación de costo-efectividad (RICE: USD 2727,75), con posición dominante frente a la calidad deficiente (6,14 veces el PIB per cápita de ahorro) y con un impacto presupuestal de USD 2.904.392. Conclusiones: La buena calidad del CPN en el departamento del Cauca durante 2018-2020 fue costo-efectiva y dominante por ser de menor costo y mayor efectividad.

Background: The department of Cauca in Colombia is multiethnic, multicultural, and biodiverse, also with large differences in low birth weight (LBW), perinatal mortality, and late neonatal mortality among municipalities. Objective: To determine the cost-effectiveness relationship of antenatal care (ANC) when it has had good quality compared to that which has had poor quality with respect to low birth weight in the department of Cauca between 2018 and 2019. Method: Economic evaluation with epidemiological cohort design historical from the perspective of the payer institution. Incremental cost-effectiveness ratio (RICE), sensitivity analysis, and budgetary impact were calculated. Results: The incidence of LBW was 8.3% (348/4182). Poor quality in ANC increased the risk of LBW (OR: 3.38; CI95%: 1.05-8.2), good quality had a better cost-effectiveness ratio (RICE: USD 2727.75), with dominant position against poor quality (6.14 times the GDP/capita savings) with a budgetary impact of USD 2,904,392. Conclusions: The good quality of the ANC in the department of Cauca during 2018-2020 was cost-effective and dominant because it is lower cost and more effective.

Manejo de embarazos únicos con diagnóstico antenatal de vasa previa / Management of singleton pregnancies with prenatal diagnosis of vasa previa

Introducción: vasa previa (VP) corresponde al paso de los vasos umbilicales por las membranas amnióticas, sin protección de gelatina de Wharton o placenta, antes de la presentación fetal, sobre el orificio cervical interno. Pese a su baja incidencia, el diagnóstico prenatal es relevante por las graves consecuencias que puede tener esta patología en caso de no ser diagnosticada. El objetivo de esta revisión es presentar la evidencia disponible para el manejo de embarazadas con diagnóstico antenatal de VP. Materiales y métodos: analizamos todos los estudios publicados (prospectivos, retrospectivos y reporte de casos) entre los años 1999 y 2023, con diagnóstico VP en embarazo único, reportando la edad gestacional de interrupción y el resultado neonatal. Resultados: incluimos 19 investigaciones (18 en la búsqueda primera y una adicional por relevancia). Las pacientes con manejo intrahospitalario desde las 34 semanas tuvieron mayor latencia al parto, mejores resultados neonatales y menor tasa de cesárea de urgencia que las pacientes con manejo ambulatorio. La edad gestacional de interrupción es variable entre los estudios, sin embargo, no se evidenció beneficio de interrupción a las 34 semanas comparado con manejo expectante hasta las 37 semanas de edad gestacional. Conclusión: existiría beneficio de hospitalización entre las 32-34 semanas en mujeres con diagnóstico de VP, siendo razonable la interrupción cercana a las 37 semanas por cesárea electiva.

Introduction: vasa previa (VP) corresponds to the passage of the umbilical vessels through the amniotic membranes, without the protection of Wharton's gelatin or placenta, in front of the fetal presentation, over the internal cervical os. Despite its low incidence, prenatal diagnosis is relevant due to the severe consequences of this pathology if the diagnosis is missed. This review presents the available evidence for pregnant women's management with an antenatal diagnosis of VP. Materials and methods: we analyzed all the studies published (prospective, retrospective, and case reports) between 1999 and 2023, with a diagnosis of VP in a single pregnancy, reporting gestational age at delivery and neonatal outcome. Results: We included 19 investigations (18 in the first search and another for relevance). Patients with in-hospital management from 34 weeks had a more extended latency period until delivery, better neonatal outcomes, and a lower rate of emergency cesarean section than patients with outpatient management. The gestational age at birth is variable between the studies; however, no benefit of delivery at 34 weeks was evidenced compared with expectant management until 37 weeks of gestational age. Conclusion: there would be a benefit of hospitalization between 32-34 weeks in women diagnosed with VP, being reasonable to schedule the delivery close to 37 weeks by elective cesarean section.

Consensus Statement of the Neurodevelopmental Pediatrics Chapter of Indian Academy of Pediatrics (IAP) on the Management of Children With Down Syndrome

Justification: The diagnosis of Down syndrome (DS) is easily made clinically but the management is multi-disciplinary and life-long. There is no standard protocol available for its management in India. Process: A committee was formed under the Indian Academy of Pediatrics (IAP) chapter of Neuro developmental pediatrics consisting of 20 experts working in the related field. The various aspects of the condition were discussed and allotted to the concerned experts related for preparing the guidelines. The material received was collated to form a set of guidelines, which were reviewed by the committee, and a consensus statement made. The guidelines were then approved by the chapter, and by the IAP. Objectives: To define the condition and to look into the various aspects of antenatal and postnatal diagnosis. To explain briefly about the involvement of the various systems that are involved and formulate recommendations for management. To recommend early and sustained interventional therapies to enable children with DS lead an independent life. Recommendations: The stress on bio-psycho-social strategy for the management of children with DS is reiterated, and the need for a medical, social and rights model is recommended after each section. The age-wise recommendations are also highlighted in addition to the recommendations under each system.

Maternal Characteristics of Full-Term Birth Asphyxia Neonates

Background: In developing countries, perinatal hypoxia is still a leading cause of mortality and disability. In 2011, the infant mortality rate dropped from 92 per 1000 live births in 1991 to 43 per 1000 live births. However, neonatal mortality in Bangladesh remains high, accounting for more than half of all deaths under the age of five and more than two-thirds of infant mortality. As a result, any qualities that can operate as a risk factor for prenatal asphyxia can be quite beneficial. The aim of the study was to observe the maternal characteristics of perinatal asphyxia in full-term pregnancies. Material & Methods: This cross-sectional descriptive study was conducted at the Department of Obstetrics and Pediatrics, Rangpur Medical Collage, and Hospital, Rangpur, Bangladesh. The study duration was 2 years, from January 2012 to December 2013. The study was conducted with a total of 60 cases of birth asphyxia, who were delivered or admitted into the study hospital. Results: In 70% of cases, the mother was Primipara. Among the neonates, 61.67% were male, and 38.33% were female. Only 33% of the case neonates had received regular antenatal check-ups, while 55% had irregular check-ups, and 11.67% had no antenatal checkups. According to the grading of asphyxia, 51.67% of neonates had moderate asphyxia, 20% had mild asphyxia, and 28.33% had severe asphyxia. The mean serum sodium value in mild, moderate, and severe asphyxia were 135.33, 123.42, and 121.53 mmol/L respectively. Mean serum potassium values were 4.11, 4.86, and 5.51 mmol/L respectively. Mean serum creatinine 0.72, 1.00, and 1.83 mg/dl respectively. Mean blood urea levels were 36.17, 58.97, and 88.06 mg/dl respectively. A significant difference was observed between the mean values of serum electrolytes and patients’ asphyxia grade. Conclusion: The study findings revealed that birth asphyxia was more common among vaginal deliveries and irregular or no neonatal care cases. Primipara patients had a higher likelihood of neonatal asphyxia. Serum electrolyte levels varied significantly based on the grade of asphyxia.

Birth Preparedness and Complication Readiness among Pregnant Women in Rural Area of District Sonipat, Haryana, India: A Cross Sectional Community Based Study

Introduction: Birth Preparedness and Complication Readiness (BPCR) is an important intervention included by WHO as essential elements of antenatal care package. It is often delivered to pregnant women through their active participation by health care provider during antenatal care or initiated/followed up through visits to the homes of pregnant women by community health workers. Objectives: To determine the knowledge and practice regarding BPCR and to identify factors associated with it among rural pregnant women. Method: Cross-sectional study was conducted in rural field practice area of Community Medicine Department of a medical teaching institutes. A total of 210 pregnant women who were in the second and third trimesters of pregnancy were selected by simple random sampling and interviewed for data collection. Results: Mean age of study subjects was 24.14 + 3.88 years.The highest number of women was in the age group of 20-29 years (84.8%). More than half (57.6%) mothers had observed at least two or more components of BPCR. Maximum number of females had identified facility for delivery (63.8%) followed by transportation (60.9%). Identification of potential blood donor by mothers was low (14.3%). Bleeding was most commonly identified danger symptom in all three phases of child bearing. Knowledge regarding danger signs was significantly associated with birth preparedness. Conclusion: In the present study, practice of all components of BPCR by mothers was very low. Bleeding was the most commonly identified danger symptom during all three phases i.e., pregnancy, child birth and after birth.Knowledge regarding other danger signs was highly inadequate.

Barriers and Solutions Pertaining to Pradhan Mantri Matru Vandana Yojana (PMMVY) Implementation in a Block of West Bengal: A Mixed-Methods Approach

Introduction: Improvement of maternal health care services will not only put a positive impact on maternal health, but also on the health of the new born. Objectives: This study was conducted to estimate the proportion of eligible beneficiaries who received the benefits provided by the scheme, to identify the barriers faced by the beneficiaries and health providers related to the scheme and to find possible solutions to overcome the barriers found as suggested by them in a block of West Bengal. Method: A cross-sectional study with sequential explanatory mixed-method approach was conducted in a block of West Bengal from January-December 2021. Quantitative data was collected from the digital portal of PMMVY. All beneficiaries who had their Last Menstrual Period (LMP) on and after 1st March 2020 up to 31st December 2020 were included. To identify the barriers faced and suggest possible solutions, Focused Group Discussions (FGDs) were held with the beneficiaries, ANMs and ASHAs and Key-Informant Interviews (KIIs) with the Block Medical Officer and Data Entry Operator. Data were analyzed using SPSS version 25.0. Descriptive statistics were used to summarize quantitative data while qualitative data were analyzed in the form of themes, codes and verbatim. Results: Total eligible beneficiaries for the three installments were 1066, 917 and 708 respectively. About 95.5% beneficiaries received the first installment, 93.0% received the second and 98.3% had received the third installment. The broad themes [codes] generated from the FGDs were challenges during antenatal care [ANC refused, home visit preferred, home ANC difficult, lockdown], challenges related to the PMMVY scheme [documents unavailable, incomplete forms, payment issues], possible solutions [prepare pre-requisites beforehand, provide cash]. Widely two main themes emerged from the KIIs: Form related issues and Payment issues. Conclusion: Coverage of PMMVY scheme in the block was satisfactory. However, speeding the payment process and stricter monitoring of the scheme is required

A Community-Based Trial on The Comparison of Efficacy, Safety and Cost Effectiveness of Ferrous Sulphate and Ferrous Ascorbate for Anaemia in Pregnancy In Madhya Pradesh, India

Background: Anaemia has significant impact on health of the fetus as well as that of mother. Increased need of iron during pregnancy especially after 2nd trimester makes iron supplementation mandatory. Ferrous ascorbate is known to exist intact inside the gastrointestinal tract due to the stable chelation of iron with ascorbate. This compound does not dissociate due to any of the food inhibitors. The aim is to study the effec-tiveness of Ferrous Ascorbate and Ferrous sulphate in terms of compliance and cost effectiveness of manage-ment of anaemia in pregnancy. Methodology: Study design: Quasi Experimental study, Study area: District Vidisha, Study participants: Preg-nant women of first trimester registered during the study period in the selected Anganwadis/ Gram Arogya Kendra (GAK), Sample size: 240 antenatal mothers. Results: Baseline mean haemoglobin was 11.31±1.05 gm/dl. The mean increase in Ferrous Sulphate was 0.55 gm/dl, and in Ferrous ascorbate was 1.27 gm/dl. Ferrous Sulphate was less compliant than Ferrous ascorbate, and has higher efficacy and lesser side effects. Only Rs. 10.2 additional cost per antenatal mothers for increase of ≥1gm% in Hb will be borne by government if Ferrous Sulphate is replaced by Ferrous Ascorbate. Conclusions: Study results show statistically significant difference in rise of haemoglobin amongst the ante-natal mothers consuming Ferrous ascorbate over Ferrous Sulphate

Effect of antenatal class attendance on fear of childbirth and antenatal stress

ABSTRACT OBJECTIVE To assess the effect of attending antenatal classes on fear of childbirth and antenatal stress in nulliparous pregnant women. METHODS A total of 133 nulliparous pregnant women participated in the study, which had a quasi-experimental design. Data were collected by a descriptive data form, the Wijma Delivery Expectancy/Experience Questionnaire, and the Antenatal Perceived Stress Inventory (APSI). RESULTS A significant correlation was found between antenatal class attendance and having a high schooling level and an intended pregnancy (p < 0.05). The mean fear of childbirth score of pregnant women was 85.50 ± 19.41 before the training and 76.32 ± 20.52 after the training, and the difference between these scores was significant (p < 0.01). Fear of childbirth score were not significantly different between the intervention group and the control group. The mean APSI score of pregnant women in the intervention group was 22.32 ± 6.12 before the training and 21.79 ± 5.97 after the training. However, this difference was not statistically significant (p = 0.70). CONCLUSION The fear of childbirth score decreased significantly in the intervention group after the training.

Antenatal care services in decreasing under-five mortality / Serviços de cuidados pré-natais na redução da mortalidade de menores de cinco anos

Abstract Objectives: the first five years of life are critical for children's physical and intellectual development. However, the under-five mortality rate in South Asia and ASEAN is relatively high, caused by complex etiologies. This paper identifies maternal high-risk fertility behaviors and healthcare services utilization and examines predictors of under-five mortality (U5M) in 7 Asian (South Asia - ASEAN) developing countries (Indonesia, Myanmar, Cambodia, Philippines, Bangladesh, Nepal, and Pakistan). Methods: a multivariate logistic regression model with a complex survey was used to examine predictors of U5M on the frequency of U5M adjusted for comorbidities. Results: according to multivariate models (model 2), U5M was 2.99 times higher in mothers with low weight at birth infants than in mothers without low weight at birth infants (aOR= 2.99; CI95%=2.49-3.58); Mothers without antenatal care contacts were 3.37 times more likely (aOR= 3.37; CI95%=2.83-4.00) to have a U5M than mothers with eight or more antenatal care contacts; U5M in Indonesia was 2.34 times higher (aOR= 2.34; CI95%= 1.89-2.89). It is investigated that antenatal care serves as a predictor in decreasing U5MR. Conclusions: in order to achieve significant U5MR reduction, intervention programs that encourage antenatal care consultations should be implemented.

Resumo Objetivos: os primeiros cinco anos de vida são críticos para o desenvolvimento físico e intelectual da criança. No entanto, a taxa de mortalidade de menores de cinco anos no sul da Ásia e na ASEAN é relativamente alta, causada por etiologias complexas. Este artigo identifica comportamentos maternos de fertilidade de alto risco e utilização de serviços de saúde e examina preditores de mortalidade abaixo de 5 anos (MM5) em 7 países em desenvolvimento da Ásia (Sul da Ásia - ASEAN) (Indonésia, Mianmar, Camboja, Filipinas, Bangladesh, Nepal e Paquistão). Métodos: um modelo de regressão logística multivariada foi usado para examinar preditores de MM5 na frequência de MM5 ajustado para comorbidades. Resultados: na análise multivariada (modelo 2), U5M foi 2,99 vezes maior em mães com bebês com baixo peso ao nascer do que em mães sem bebês com baixo peso ao nascer (aOR= 2,99; IC95%=2,49-3,58); as mães sem contatos de cuidados pré-natais tiveram 3,37 vezes mais probabilidade (aOR=3,37; IC95%=2,83-4,00) para ter MM5 do que mães com oito ou mais contatos de cuidados pré-natais; MM5 na Indonésia foi 2,34 vezes maior (aOR= 2,34; IC95%= 1,89-2,89). Investiga-se que os cuidados pré-natais funcionam como um preditor na diminuição da MM5. Conclusões: para uma redução significativa da MM5, devem ser implementados programas de intervenção que estimulem as consultas pré-natais.

Participação paterna no pré-natal, parto e pós-parto: um estudo sobre a perspectiva do pai / Paternal participation in antenatal, labour and postpartum: a study about the father's perspective / Participación paterna en pré-natal, parto y pos-natal: un estudio sobre la perspectiva del padre

Este estudo parte de uma exploração mais ampla sobre as transformações do exercício paterno na contemporaneidade. O objetivo foi investigar a participação do pai nas consultas pré-natais, no parto e no pós-parto sob a perspectiva masculina. Para tanto, realizou-se uma pesquisa qualitativa, na qual foram entrevistados quinze pais primíparos. Os resultados foram analisados utilizando o método de análise de conteúdo na sua vertente categorial. Da análise do material, emergiram diversas categorias de análise. Contudo, para atingir os objetivos formulados no presente trabalho, foram discutidas as categorias "presença do pai nas consultas de pré-natal", "presença do pai na sala de parto" e "rede de apoio familiar". Os resultados indicam que, na atualidade, muitos homens desejam participar do ciclo gravídico-puerperal. Entretanto, sua presença nem sempre é facilitada, em especial, devido aos estereótipos de gênero associados ao universo obstetrício como um espaço naturalmente feminino. A partir da análise das entrevistas concluiu-se que a participação do homem durante o pré-natal, parto e pós-parto é um fator positivo, pois fortalece os vínculos familiares

This study, part of a broader investigation on the transformations of fatherly exercise in contemporary times, and aimed to investigate the father's participation in prenatal consultations, childbirth and postpartum from the man's perspective. Therefore, a qualitative research was conducted, with fifteen primiparous parents wich were interviewed. The results were analyzed according to the content analysis method in each categorical aspect. From the analysis of the material, several categories of analysis emerged. To achieve the objectives formulated in this study, the categories presence of the father in prenatal consultations, presence of the father in the delivery room and family support network will be discussed. The results showed that, today, many men wish to participate in the pregnancy-puerperal cycle, however their presence is not always facilitated, especially due to the gender stereotypes associated with the obstetrical universe as a naturally female space. This concludes that the participation of men during prenatal, delivery and postpartum is a positive factor, because strengthens family bonds

Este estudio, parte de una investigación más amplia sobre las transformaciones del ejercicio paterno en la época contemporánea, tuvo como objetivo investigar la participación del padre en las consultas prenatales, el parto y el pós-parto desde la perspectiva del hombre. Para ello se realizó una investigación cualitativa, en la que se entrevistó a quince padres primíparos. Los resultados se analizaron según el método de análisis de contenido en su aspecto categórico. Del análisis del material surgieron varias categorías de análisis. Para lograr los objetivos formulados en este estudio se discutirán las categorías presencia del padre en consultas prenatales, presencia del padre en la sala de partos y red de apoyo familiar. Los resultados mostraron que, hoy en día, muchos hombres desean participar en el ciclo embarazopuerperal, sin embargo su presencia no siempre se facilita, especialmente por los estereotipos de género asociados al universo obstétrico como un espacio naturalmente femenino. Se concluye que la participación de los hombres durante el prenatal, parto y posparto es un factor positivo, ya que fortalece los lazos familiares

Antenatal women's childbearing practices at the Niger Delta university teaching hospital, Okolobiri Nigeria

Background: Overpopulation in a community or a country reflects high fertility desires of its citizens. A country can only progress meaningfully if its resources and amenities can provide for all its citizens. Objectives: To examine the childbearing practices of antenatal attendees at the Niger Delta University Teaching Hospital, Okolobiri, Nigeria and whether there is any suggestion of fertility decline or transition. Materials and Methods: A cross-sectional study of two hundred and fifty-two women who had antenatal care in the hospital during the study period. Data was collected using a structured self-administered questionnaire with a reliability coefficient of 0.85. Data collected were analysed using IBM SPSS Statistics version 25. Statistical significance was a p-value <0.05. Results: The mean age of the respondents was 30.5 ± 5.9 years. More than half (53.6%) had tertiary education and 39.3% had secondary education. Only 29.4% were housewives/unemployed. The median parity was 2 and 229 women accounted for previous deliveries of 596 babies. The median desired total number of children was 4 (range 1 to 8). More than half (56.3%) did not believe in spacing after the first child. Seventy-six (30.2%) had no knowledge of modern contraceptives. There was a significant relationship (p - 0.018) between child sex preference and number of births. Conclusion: With a current median parity of two children/woman and desired total number of children of a median of four children/woman, the childbearing practices of the population studied may not result in a fertility rate far below the Nigeria national average of 5.3 children per woman. Nevertheless, a study to derive the total fertility rate in the study population is necessary to determine whether or not there is ongoing fertility transition.

Facteurs associés au recours tardif à la première consultation prénatale dans le district sanitaire de Gao, Mali / Factors associated with late antenatal care in health district in Gao, Mali

Les soins prénatalssont le service fourni aux femmes enceintes afin d'assurer les meilleures conditions de santé pour les femmes et les fœtus pendant la grossesse.Pour être efficace, la consultation prénatale(CPN)doit débuter à un stade précoce de la grossesse; l'organisation mondiale de la santérecommande quatre visites prénatales, la première visite devant avoir lieu avant le troisième mois de la grossesse. L'objectifétaitd'étudier les facteurs associésau recours tardifsà la première consultationprénatale. Cette étude de cas témoin appariéea porté sur des femmes enceintes en consultation prénatale. Au total 447 femmes ont été sélectionnées (cas = 149 témoins = 298). Les logiciels épi info version 7.2.2.6 et SPSS version 25 ont été utilisés pour respectivement saisir et analyser les données.Le model de régression logistique binaire a été utilisé pour estimer les Odds Ratios.La profession(femme au foyer)ORa = 7 [1,20-46,43], le moyen de déplacement ORa = 3,16 [1,11-9,03]etl'assurance maladie ORa = 6,32 [1,30-30,65] étaient significativementassociés au recours tardif à la première consultation. En plus, celle qui n'avaitpasplanifié sa grossesse ORa= 11,16 [5,49-22,68], et celle qui neconnaissait pasla période de début de CPN ORa = 5,36[2,07-13,85]étaient susceptiblesde débuter tardivement leur première consultation.La mise en place des interventions adaptées telle que l'assurance maladie, l'autonomisation des femmes et la sensibilisation pourraient améliorerlafréquentation des services de CPN de façon précoce.

Prenatal care is the service provided to pregnant women to ensure the best health conditions for women and fetuses during pregnancy. To be effective, antenatal care (ANC) must begin early in pregnancy;the first visit occurring before the third month of pregnancy. The objective was to study the factors associated with late attendance at the first prenatal visit. This matched case-control study included pregnant women seen at antenatal clinics. A total of447 women were selected (cases = 149 controls = 298). Epi Info version 7.2.2.6 and SPSS version 25 were used to enter and analyze the data, respectively. The binary logistic regression model was used to estimate the Odds Ratios. Results: Occupation (housewife) ORa = 7 [1.20-46.43], means of travel ORa = 3.16 [1.11-9.03] and health insurance ORa = 6.32 [1.30-30.65] were significantly associated with late first antenatal care. In addition, those who had not planned their pregnancy ORa= 11.16 [5.49-22.68], and those who did not know the timing of ANC ORa= 5.36 [2.07-13.85] were likely to start their first visit late. The implementation of appropriate interventions such as health insurance, women's empowerment and awareness raising could improve early ANC service attendance.

Comparison of Pregnancy Outcomes of Booked and Unbooked Patients in the Niger Delta

Background:Sub-Saharan African countries have some of the worst maternal mortality ratios in the world sub-regions. Uncoordinated antenatal care practices and delivery outside health institutions are some of the determinants of thesedeaths experienced in the region. The objective of the study is todetermine some of these erring behavioral antenatal practices that are inimical to good obstetric outcomes and how health care planners can use the results to close thesegaps of maternal mortality and save lives.Method:This study was a cross sectional retrospective study of the women who delivered at The Niger Delta University Teaching Hospital, Okolobiri, between 1 st June,2021 to 1st June, 2022. The study compared the maternal and fetal outcomes between the booked andunbooked patients who delivered during this period. Relevant data to the study were extracted from patients' medicalrecords using a proforma and data collected entered SPSS Version 25 foranalysis.Results:Three hundred and forty-six patients participated in the stud, 72.3 % were booked and 27.7%were unbooked. Place of delivery N = 253, 75.5 % delivered in health facilities and 24.5 in non-Health facilities. Unbooked patients have prolonged labor lasting more than 24 hours, suffered more blood loss during delivery, their babies have more unfavorable one minute Apgar, all compared to outcomes of the booked patientsConclusion:Booked patients have more favorable pregnancy outcomes compared to the unbooked patients. Health care planners and care providers should devote more time and resources to unbooked patients to have favorable pregnancy outcomes

Does Combining Antenatal Care Visits at Health Posts and Health Centers Improve Antenatal Care Quality in Rural Ethiopia?

BACKGROUND: Even though quality maternal care is crucial for the well-being of women and their newborns, the inferior quality of antenatal care in rural Ethiopia is a timely concern. This study aimed to investigate the effects of combining antenatal care visits at health posts and health centers on improving antenatal care quality in rural Ethiopia. METHODS: Using the 2019 Ethiopia Health Extension Program assessment done by MERQ, we extracted and analyzed the survey responses of 2,660 women who had received at least one antenatal visit from a primary health care unit. We measured the cumulative count of quality of antenatal care using the Donabedian model. To model the differences in the quality of antenatal care at health posts and health centers, we used zero truncated Poisson regression and reported incidence risk ratios with their 95% confidence intervals. RESULTS: The quality of antenatal care increased by 20% (adjusted IRR= 1.20 [1.12­1.28]) when antenatal care reception was mixed at health posts and health centers, compared to those who received all antenatal care only from health posts. Quality differences based on socioeconomic status and setting variations were observed as predictors of quality of care, even if women received antenatal care at both health posts and health centers. CONCLUSIONS: Combining antenatal care provision from health posts and health centers should be sustained as one of the antenatal care quality improvement strategies in rural parts of Ethiopia while ensuring the equitable provision of quality care across socioeconomic groups and between agrarian and pastoral settings.

Impact of COVID-19 on the antenatal care services utilization in the region of Guelmim Oued Noun, Morocco

Background: Globally, the covid-19 pandemic has seriously impacted access to healthcare facilities across the world, although there is little evidence on how the pandemic affects the use of essential healthcare in the world. Objective: This study sought to evaluate the impact of the covid-19 pandemic on antenatal indicators in the region of Guelmim Oued Noun, Morocco. Methods: The aggregated data was delivered by regional health authorities covering the period from January 2017 to December 2020. The interrupted time series was mobilized to conduct statistical analysis. Results: The descriptive results revealed a steady decline after the Covid-19 pandemic in Antenatal indicators. The results of the regression model showed a negative impact of the pandemic on the antenatal recruitment rate (ß2 = - 16.14; p < 0.01), recruitment rate of women in antenatal visits the 1st quarter of pregnancy (ß2 = -2.09; p < 0.01), antenatal visit completion rate (ß2 = -18.10, p>0.05), average number of visits/pregnancies (ß2 = -15.65, p<0,05). Conclusion: The effect of the covid-19 pandemic on antenatal rates was significant for almost the indicators studied. Future studies should be focused on the impact of the pandemic on postnatal and immunization services on the national scale.

Breastfeeding Education: A Scoping Review

@#The aim of this scoping review was to explore the evidence related to breastfeeding education in postpartum mothers from relevant databases (PubMed, Science Direct, and Wiley). There were nine eligible studies in which all of them used quantitative design. The data was organized into seven themes including targets, materials, methods, media, officers and places, time, and the effect or influence of breastfeeding education. Almost all (8/9) articles informed breastfeeding education targets. There were 5/9 articles that reported the methods, 6/9 articles discussed the media, 8/9 articles talked about the officers and places, 7/9 articles concerned about the time of implementation, and all studies reported the effect of breastfeeding education. Breastfeeding education included at least 5 existing components. Breastfeeding education must be planned properly and must be carried out continuously from the antenatal until the postnatal period.