Knowledge Attitude and Practice towards Antenatal Care among Pregnant Women Attending for Antenatal Care in SOS Hospital at Hiliwa District, Benadir Region, Somalia

Background: Antenatal care is one of the strategies aimed at addressing maternal mortality as it facilitates the identification and avoid pregnancy related problems and save lives of mothers and babies. Purpose: This study aimed knowledge attitude and practice towards antenatal care among pregnant women attending for antenatal care in SOS Hospital, Hiliwa District, Benadir region, Somalia during the period of the study from April 2021-July 2021. Methodology: The study was descriptive cross-sectional, retrospective hospital based;a total of 60 of pregnant women were enrolled in this study. Data were collected through interview method using structured questionnaire. Data analysis was used Statistical Package for Social Science version 20 for analysis (SPSS). Results: The study discovered a total of 60 respondents have participated of which 45 (75%) had knowledge towards antenatal care, while the study found that the sources of antenatal care information was;23 (38%) from health care providers at health centers and 10 (17%) from husbands. Among the study respondents 48 (80%) have convenience and accepted the utilization of antenatal care and a total of 51 (85%) were seeking permission for antenatal care visit. Also study respondents about 35 (58%) utilized antenatal care visit during their previous pregnancies and 25 (42%) did not. About 22 (36%) were preferred mother and child health centers, 10 (16%) were preferred public hospitals and few proportion 2 (5%) were preferred private hospital for antenatal care visit respectively. Finally the study showed that, multigravida, gestational months, seeking permission and spouse accompany to the antenatal care visit and level of awareness significantly contributed to the utilization of ANC by pregnant women in this study. Significant difference was strongly observed (P = 0.000). Conclusion and Recommendations: In conclusion, there was good knowledge and positive attitude towards ANC despite poor antenatal care utilization, the study recommended;the federal ministry of health incorporation with federal member states ministry of health should intensify national health education programmers aimed at promoting utilization of antenatal care services by increase the knowledge of mothers about importance of antenatal care and timely antenatal care booking and continue provide capacity building for health care providers across the country on national antenatal care ANC guidelines and policies.

Effect of In-Service Training Program on the Practice of Healthcare Workers toward Malaria Prevention and Treatment Guidelines during Pregnancy in Health Facilities in Jowhar District, Somalia

Malaria is generally considered a major public health problem in Somalia. Providing early diagnosis and effective treatment is the key element of malaria control strategies in malaria-endemic countries, including Somalia. This required to advocate and ensure health worker’s adherence to the national malaria guidelines at all levels of health care service. A well-designed in-service training program may improve the level of health worker’s adherence to national malaria treatment guidelines, although results have been inconsistent. This is an interventional health facility-based pre and post comparative study aimed to assess the effect of an in-service training program on the practice of healthcare workers toward malaria prevention and treatment guidelines, during in pregnancy in health facilities in Jowhar district, Middle Shabelle region of Somalia. The study was implemented in three phases: pre-intervention phase, intervention phase and post-intervention phase. The sample size consisted of (n = 150) health workers who were selected from ten public health facilities using proportional to size sampling;the data collection adopted in this research is composed of a structured interview questionnaire and observational checklist. Data was analyzed through the application of descriptive statistical analysis that includes frequency and percentage and the Chi-square (x2) test was used to test the associations among variables using SPSS software version 25. The study showed that the level of health workers’ awareness of the national malaria guidelines in the treatment and prevention of malaria in pregnancy was found to be good before the intervention 89 (59.3%) and this proportion increased to 150 (100%) post-intervention of the training program. A significance difference has been observed between health workers’ awareness and their adherence to the malarial guidelines at pre-test and post-test with a p-value 0.000. The proportion of health workers who attended previous training on national malaria guidelines in the treatment and prevention of malaria in pregnancy increased from 46 (30.7%) at the pre-test to 150 (100%) after the post-test. A significant difference was observed in the training status among different categories of health worker and their adherence to the guidelines during the pre- and post-intervention of the training program, with a p-value of 0.000. The result showed that health workers were adhering to the guidelines at the pre-test 33 (22%), this increased after the post-test to 87 (58%). The knowledge of the need to adhere led to an increase in the adherence rate after the training program intervention. The study reveals that inadequate awareness was most reason for the non-adherence in the majority of the health workers as indicated by 89 (59.3%) at the pre-test and 56 (37.3%) in the post-test. However, difference was not significant between the availability of anti-malaria drugs in the facilities and the health workers’ adherence to the guidelines p-value 0.355 at the pretest and p-value 0.258 at post-test. The study concluded that the in-service training program significantly improved health workers’ knowledge and practice to the national malaria guidelines in the treatment, and prevention of malaria in pregnancy. The researcher recommends that the national malaria control programme (NMCP) of the Federal Ministry of Health should provide continuous regular in-service training to frontline healthcare workers at (facility and Community-based) to upgrade their skills and knowledge towards the malaria guidelines, disseminate job aids to the health facilities and undertake regular monitoring to ensure effective implementation of the national malaria treatment guidelines in the treatment and prevention of malaria in pregnancy in achieving desired proper case-management practices of malaria in pregnancy at all levels of health care service.

Factors Affecting Adherence to National Malaria Treatment Guidelines in the Diagnosis, Treatment and Prevention of Malaria in Pregnancy among Healthcare Workers in Public Health Facilities in Jowhar District, Somalia

Introduction: Early diagnosis and effective treatment remain critical elements of a malaria control strategy in preventing mortality and reducing the incidence of severe malaria illness in Somalia. In Sub-Saharan African countries showed different levels of adherence to their national malaria guidelines for malaria treatment and prevention in pregnancy, while experiences from many countries indicated several challenges and constraints that may make the implementation of the guidelines difficult. Objective: The study aimed to assess factors affecting adherence to revised national malaria treatment guidelines in the diagnosis, treatment and prevention of malaria in pregnancy among health care workers in public health facilities in Jowhar District, Somalia. Methodology: A cross-sectional health facility-based study conducted in Jowhar district. A structured interview questionnaire was used for data collection from (n = 150). Healthcare workers selected from ten public health facilities using proportional to size sampling and an observational checklist was used to assess patient’s medical prescriptions to review their conformity to the guidelines and the availability of antimalarial drug, malaria diagnostic tests (mRDTs and microscopy) and job aids, such as the national malaria treatment guidelines, clinical algorithm (flow chart), malaria rapid diagnosis tests mRDTs’ use of wall charts, and drug dose wall charts at the facilities. Data was analyzed through the application of descriptive statistical analysis that includes frequency, and percentages by using Statistical Package for Social Sciences (SPSS) Version 25. Results: Healthcare workers interviewed were 89 (59.3%) aware of the existence of the revised national malaria treatment guidelines. However, 61 (40.7%) were not aware of the guidelines and only 46 (30.7%) had been trained for the national malaria guidelines in the treatment and prevention of malaria in pregnancy. Overall, 33 (22%) of the workers reported to adhere to guidelines, with 117 (78.0%) reported non-adherence. A significant difference was observed in the training status among different categories of health workers with (p-value of 0.022). Conclusion and Recommendation: In conclusion, the study showed that adherence to the national malaria guidelines for Malaria diagnosis, treatment and prevention in pregnancy among health care workers are associated with inadequate awareness of the revised national malaria guidelines among healthcare workers, inadequate supply of diagnostic tests (mRDTs and microscopy) at the health facilities and lack of access to revised national guidelines for malaria diagnosis and treatment, a lack of regular supervision and monitoring and lack of in-service training respectively. The national malaria control program should intensify efforts to strengthen the readiness of the public health facilities in the district to handle malaria in pregnancy cases, diagnosis, treatment and prevention, improve the availability of antimalarial drugs and malaria diagnostic tests (mRDTs and microscopy), job-aids at the health facilities and undertake regular monitoring and on job training to ensure the proper use of the guidelines at all levels of health care service delivery points across the country.

The Epidemiology of Induction of Labor among Women Aged 15 - 49 Who Delivered at Shaafi Hospital in Hodon District, Mogadishu Somalia 2020

Background: Induction of labor is an artificial termination utilized to decrease both maternal and neonatal morbidity and mortality. The study was aimed to assess the epidemiology of induction of labor among women aged 15 - 49 who delivered at Shaafi Hospital in Hodon District, Mogadishu Somalia 2020. Methodology: A cross-sectional and retrospective hospital-based study was conducted among 30 women aged 15 - 49 who had undergone induction of labor who were delivered at Shaafi Hospital Mogadishu during the period of the study from May-July 2020. Data were collected by interview method using structured questionnaire. Data analyzed was performed using Statistical Package for Social Science version 20. Results: The study showed that the majority of respondents 12 (40%) had undergone induction once time previously, followed by 8 (27%) had undergone induction previously two times, while 6 (20%) had undergone previously three times, 4 (13%) more than four times. 21 (70%) were delivered Spontaneous Vagina delivery (SVD), 6 (20%) were Cesarean section (CS) and 3 (10%) instrumental vaginal delivery. A total of (60%) were delivered in public hospitals, followed by (23%) were delivered in private hospitals and 5 (17%) home delivery. In addition the reasons of induction of labor a total of 27 (90%) were post term, followed by 2 (7%) were Intrauterine fetal death (IUFD), while few proportion of 1 (3%) were Pregnancy induced hypertension (PIH). Finally, the study revealed that the socio-demographic and obstetrical determinants such as age and daily meal intake as well as antenatal care visit and reasons for induction of labor e.g. Post term (Post-mature), Intrauterine fetal death (IUFD) and Pregnancy induced hypertension (PIH) showed significant association with their the induced labor (P Conclusion and Recommendations: The study recommended that ministry of health especially maternal and reproductive health unit should ensure that every pregnant woman has access to skilled maternal counseling and improve quality of antenatal, develop a national guideline of induction labor and continue training health workers at health facilities and monitor its implementations across the country.

Knowledge, Attitude and Practice regarding Intermittent Preventive Treatment (IPTs) of Malaria among Pregnant Women Attending for Antenatal Care in Benadir Hospital at Benadir Region, Somalia

Background: Malaria in pregnancy is a preventable public health concern leading to a high prevalence of maternal morbidity, maternal mortality and adverse birth outcomes. Intermittent Preventive Treatment during pregnancy using Sulfadoxine-Pyrimethamine (IPTp-SP) is one of the main strategies used to prevent malaria in pregnancy. This study was aimed to determine knowledge attitude and practice regarding intermittent preventive treatment IPT of malaria in pregnancy utilization among pregnant women attending antenatal center in benadir hospital wadajir district benadir region somalia during the period of the study from April 2021-July 2021. Methods: The study was descriptive cross-sectional retrospective Hospital based. The sample size was 60 respondents of pregnant women at 20 weeks to 36 weeks of gestation. Data were collected by interview method using structured questionnaire. The data were collected and then entered to Statistical Package for Social Science version 20 for analysis. Results: The study displayed that the majority of the respondents (58%) were in the 25 - 34 years’ age group. A total of 51 (85%) were married, while 17 (28%) had primary school education. 43 (72%) were housewives while only 11 (18%) were employed. A total 32 (53%) were had gravid more than Four times, while the study showed that, the majority of mothers 39 (65%) were had knowledge about Intermittent Preventive Treatment during pregnancy using Sulfadoxine-Pyrimethamine (IPTp-SP). The study showed that majority of the respondent 25 (42%) were getting health education awareness towards IPTp were from health care providers at health centers while 8 (13%) from Friends/relatives/neighbors, followed by 4 (6%) from their husband. And 34 (57%) were had convenience IPTp-SP tablet consumption at their current pregnancy while 26 (43%) did not. Conclusion and Recommendations: Inclusion there was good knowledge and positive attitude towards IPT despite poor utilization, the study recommended the ministry of health especially health promotion, maternal and reproductive health and national malaria control programe should intensify strategies and policies to ensure 3 doses of IPTp-SP given at antenatal care centers target coverage in Somalia and provide capacity building for all health care providers. Also, there should be continuous sensitization of pregnant women on the importance of intermittent preventive treatment during each pregnancy by healthcare workers.