Effect of antenatal education on knowledge and utilization of facility-based delivery services among pregnant women in two health institutions in Alimosho, Lagos state

Background: Facility-based delivery care is an essential component of maternity care. Overtime, its under-utilization despite improvement in antenatal attendance has become a public health concern in Nigeria. To assess the effect of antenatal education on the knowledge and utilization of facility-based delivery services among pregnant women in primary health facilities in Alimosho, Lagos.Methods: Quasi-experimental design of 2 groups pre- and post-intervention was adopted and through multi-staged sampling techniques, 128 participants were selected but 117 completed the study. Self-developed structured questionnaire with reliability index of 0.76 was used for data collection. The intervention package was antenatal education package on benefits and components of delivery services. Data were analyzed using Statistical Package for the Social Sciences (SPSS) version 23 statistical package.Results: The mean age of participants in control and experimental groups was 32.3±9.60 and 34.7±8.21 years respectively. Findings revealed moderate knowledge mean score (control- 54.97±10.52; experimental-52.14±11.09) and low pre-intervention utilization mean score (control 13.33±3.41; experimental-13.17±4.21). Findings also showed significant improvement on post-intervention mean knowledge score of 52.14±11.09 versus 104.75±5.56 and a significant difference in post-intervention utilization (p=0.000) and follow-up (p=0.013) on the experimental group.Conclusions: The study concluded that the antenatal education programme had positive effect on the pregnant women’s knowledge and utilization of health facility delivery services, therefore, there is need to strengthen and intensify antenatal education at all levels of healthcare using appropriate teaching techniques.

Incentivizing (and disincentivizing) mothers to utilize maternal health services: A focus group study

@#BACKGROUND: In ensuring access to maternal health services, various strategies toward safer health practices and improved health service delivery are important ingredients to eliminate avoidable maternal deaths. A recent household survey showed that access to antenatal care (ANC) (89%) and facility-based delivery (FBD) (82.4%) in the Eastern Visayas region is significantly high, despite the extensive damage to over 500 health facilities caused by Typhoon Haiyan in November 2013. Postpartum care (PPC), however, was relatively low (37.4%). As these findings needed further elaboration, a qualitative study using focus groups was conducted. METHOD: The focus groups method was utilized to elicit responses from the mothers, BHWs, and midwives to explain what contributed to the high ANC visits, high FBD, and low PPC. Sixteen focus groups were conducted in the local dialect (Waray and Cebuano), and all discussions were audio recorded. Focus groups data were transcribed and subsequently translated to English text, then reviewed and validated by socio-linguistic academics from the region. Other data sources included debriefing session reports and expanded field notes. Nvivo 10 software was used in the coding process and data management. The data analysis referred to the principles of thematic analysis. RESULTS: The findings showed that incentives in the form of free maternal services and cash grants drive mothers to go to the health facility for antenatal care and facility-based deliveries. The free services were provided by PhilHealth (the country's social health insurance), while cash grants were awarded through the government's conditional cash transfer program and other community partners. Mothers were provided with some financial risk protection through these financial incentives. The disincentives came in the form of local ordinances, which prohibited home births. Penalties included fines for both mother and birth attendant when the mother was found to deliver outside the health facility. The unintended stigma, shame, and fear that developed in response to these ordinances also deterred home births. The significantly low use of PPC services in the health facility was attributed to the lack of advices given to mothers regarding the need for follow up care after delivery. It is also noted that there are no incentives for PPC, which may contribute to its low rates. The role of the community health workers and midwives were to inform and educate the mothers on these incentives and disincentives. However, these incentives and disincentives are extrinsic motivators and are deemed insufficient to provide long-term impact. CONCLUSION AND RECOMMENDATIONS. The implementation of the incentives and disincentives in Eastern Visayas has increased rates of ANC and FBD. The presence of these in the current environment has initially facilitated behavior change, shifting home births to facility births. However, we argue that financial incentives, with a lack of intrinsic motivation, may be insufficient to sustain long-term impact. Disincentives, in the form of local ordinances, forced mothers instead to seek care in facilities. Such an approach may eventually become less effective over time. Incentives and disincentives are both demand-side factors, and to sustain change, concurrent improvements in the supply end need to be implemented. The capacity of facilities to absorb the increased demand should be in place to provide positive experiences for mothers in the health facilities.

Association of topography with demographic and socioeconomic factors to the compliance and non-compliance of mothers to reproductive health services

@#<p style="text-align: justify;"><strong>BACKGROUND AND OBJECTIVE:</strong> In order to alleviate the reproductive health status of mothers in the Philippines, there should be a better understanding of the factors influencing their compliance to reproductive health services. The study examined the association of topography with demographic and socioeconomic characteristics on the compliance of reproductive health services.</p><p style="text-align: justify;"><strong>METHODOLOGY: </strong>This study analyzed survey data collected in 2017 among mothers in the rural community of Maasin, Iloilo, Philippines. The statistical tools Chi-square, T-test and logistic regression were used to determine the factors associated with the likelihood of mothers to comply with prenatal care, family planning and delivery care services.</p><p style="text-align: justify;"><strong>RESULTS:</strong> There is no significant difference in the number of mothers who comply with prenatal care services and family planning services between lowland and highland barangays. However, mothers from the highland barangays are more likely to have non facility-based delivery (NFBD). Only educational attainment was found to be significantly associated for prenatal services. Only parity was significantly associated with compliance to family planning services. Age, parity, educational attainment and occupation were significantly associated with compliance to delivery care service. The odds of NFBD in the highland area is 2.44 (95% CI: 1.40 to 4.23) times higher as compared to the mothers residing in the lowland area. The odds of NFBD also increases by 7% (95% CI: 3% to 11%) per year increase in age.</p><p style="text-align: justify;"><strong>CONCLUSION:</strong> There is a great need to restructure the delivery of reproductive health services to accommodate mothers from highland barangays who still opt for NFBD. Topography, demographic and socioeconomic factors should be considered in developing strategies and implementation of reproductive health care services in the Philippines. Furthermore, the researchers recommend to include in future studies other reproductive health services such as postnatal care in order to fully grasp the reproductive health in the country. </p>

¿Cuáles son los beneficios o riesgos de atender partos planificados en hospitales de baja complejidad?: síntesis rápida de evidencia / What are the benefits or risks of delivering planned deliveries in low complexity hospitals?: rapid evidence synthesis

ANTECEDENTES Y OBJETIVO A nivel mundial, alrededor de 287.000 mujeres murieron en 2010 producto de complicaciones durante el embarazo o en el parto. Se estima que la mayoría de estas muertes podrían haberse evitado con un acceso adecuado y oportuno a una atención de salud. Actualmente, se discute la pertinencia de la atención de partos en Hospitales de Baja o Alta Complejidad. En este contexto la División de Prevención y Control de Enfermedades (DIPRECE) y la División de Gestión de Redes Asistenciales solicita esta síntesis de evidencia, con el objetivo de conocer los beneficios o riesgos de cada una de las alternativas. METODOLOGÍA Se formuló una estrategia de búsqueda para ser utilizada en 6 bases de datos con el objetivo de identificar revisiones sistemáticas del tema. Se excluyeron estudios que consideraban el parto en casas por falta de acceso a establecimientos y sin la atención de personal de salud. RESULTADOS Se utilizan 4 revisiones sistemáticas de las cuales se obtuvieron los siguientes resultados: -La atención de partos con personal calificado en establecimientos no convencionales (todo establecimiento que no incluya salas tradicionales de parto en hospital, excluyendo la casa), no resultaría en una mayor mortalidad materna, neonatal, perinatal y fetal. -Episiotomía, asistencia instrumental, anestesia e inyecciones de oxitocina se utilizarían con mayor frecuencia en establecimientos convencionales que alternativos. Suturas perineales, cesáreas, aliviadores no epidurales, hemorragias post-parto y admisiones a UCI neonatal no presentaron diferencias entre ambos tipos de establecimiento. -Padres y madres tienen una visión positiva del parto en establecimientos alternativos mientras que, después de vivirlo, las madres estarían satisfechas con el parto en casa. -Los partos vaginales espontáneos ocurrirían con mayor frecuencia en establecimientos alternativos que convencionales. -La lactancia materna es mayor en madres que tuvieron parto en establecimientos alternativos de salud, que en las madres que utilizaron condiciones convencionales en salas de parto. -La salud del recién nacido (medida con Índice Apgar) no es diferente entre establecimientos convencionales y alternativos. -Para los partos asistidos en la casa, las mujeres nulíparas (o primíparas) tienden a ser derivadas a un hospital en una mayor proporción que las mujeres multíparas.