Assessment of the quality of antenatal care in Mozambique.

OBJECTIVE: To assess the quality of antenatal care and its covariates among postpartum women in Mozambique. DESIGN: Cross-sectional study. SETTING: The study was undertaken either at the maternity hospital or at home, in Mozambique, in 2019. PARTICIPANTS: A total of 393 women aged 18 to 49 years were interviewed immediately after giving birth. MEASUREMENTS: The quality of antenatal care was analysed based on the guidelines of the Ministry of Health of Mozambique: antenatal appointment in the first 16 weeks of gestation, 4 or more antenatal appointments, at least one laboratory test, at least 4 or more clinical-obstetric procedures, 3 doses of the prophylactic intermittent treatment for malaria, 2 doses of the tetanus vaccine, and counselling related to general health care. Women who reported all of these situations were classified as having had quality antenatal care. FINDINGS: All women reported at least one antenatal care visit, but only 13.0% were classified as having had quality antenatal care. Women who underwent antenatal care in previous pregnancies (aOR=4,28; 95% CI=1,45-12,62) and whose current pregnancy was planned (aOR=2,51; 95% CI=1,11-5,68) were more likely to have quality antenatal care than those who had never had access to antenatal care in previous pregnancies and those who currently had an unplanned pregnancy. It was observed that the criteria recommended by the Ministry of Health were not followed during antenatal care, especially regarding the gestational age at the beginning of antenatal care, the minimum number of consultations, performing blood tests (complete blood count, blood glucose, blood typing and Rh factor) and guidance on signs of risk in pregnancy and childbirth. KEY CONCLUSIONS: In general, the criteria recommended for quality antenatal care are not incorporated into clinical practice in Mozambique. IMPLICATIONS FOR PRACTICE: While quality antenatal care is essential to reduce maternal morbidity and mortality, many sub-Saharan countries still have low-quality antenatal care services, which is one of the reasons why these countries have the highest maternal mortality rates worldwide.

Effectiveness of different health delivery agents of parenting stimulation interventions on child development outcomes among children aged 0 to 36 months: a systematic review protocol

Objective: This review will evaluate the effectiveness of different health delivery agents of parenting stimulation interventions versus usual care, no intervention, or a different type of delivery agent on child development outcomes among children aged 0 to 36 months. Introduction: Stimulation interventions vary in terms of implementation. While some interventions are delivered by professionals, most are delivered by non-professionals. Several prior systematic reviews on this topic have been conducted; however, no known study has evaluated the effectiveness of stimulation interventions on child development by type of delivery agent. Inclusion criteria: This review will consider randomized controlled trials assessing parenting stimulation interventions delivered by different health delivery agents. These will be compared to usual care, no intervention, or a different delivery agent, targeted at caregiver-child dyads of children aged 0 to 36 months. The outcomes will include motor, language, cognitive, and socio-emotional development. The review will exclude studies including children with specific characteristics, interventions that do not focus on parenting, and protocols of randomized clinical trials. Methods: The review will include both published and unpublished studies. The key information sources to be searched are: MEDLINE, APA (PsycNet), Embase, Scopus, Web of Science Core Collection, CINAHL, VHL Regional Portal, Google Scholar, Science Direct, Theses Canada Portal, and Library and Archives Canada. Studies in English, Spanish, and Portuguese will be included. Critical appraisal and data extraction will be conducted using standardized tools. Quantitative data, where possible, will be pooled in statistical meta-analysis, or if statistical pooling is not possible, the findings will be reported narratively.

Prevalence and correlates of early sexual initiation among Brazilian adolescents.

BACKGROUND: Early adolescence is a critical stage in adolescents. This is the phase at which many young people start their sexual life early, increasing the risk of sexually transmitted infections and unintended pregnancy. Few studies have analyzed the factors associated with early sexual initiation in very young adolescents in low- and middle-income countries. Therefore, this study assessed the early sexual initiation stratified by sex and its correlates in a sample of Brazilian adolescents. METHODS: The study sample included Brazilian adolescents aged 12-14 who participated in The Study of Cardiovascular Risk in Adolescents (ERICA), a multicenter, school-based, country-wide, cross-sectional study. Early sexual initiation was defined as the first sexual intercourse at or before 14 years old. Multivariate logistic regression was used to identify independent factors associated with early sexual initiation. RESULTS: The prevalence of early sexual initiation was 7% among girls and 18% in boys. In a multivariate analysis, the adolescent's age, mother's schooling, smoking, alcohol consumption, and Tanner Stages were associated with early sexual initiation for both boys and girls. For girls, living with both parents, common mental disorders, and age at menarche were predictors of early sexual initiation, while race and type of school were correlated to early sexual initiation only for boys. CONCLUSIONS: The early sexual initiation was associated with sociodemographic, lifestyle risk factors and secondary sexual characteristics in both sexes, while there were differences between the predictors of early sexual initiation among girls and boys. It emphasizes the importance of sex education and promotes healthy lifestyles in environments through families and schools in early adolescence.