Affordability, Accessibility, and Quality of Maternal Health Care Services and Level of Satisfaction of Mothers in Rural Areas in China

Objective:This study aimed to understand the affordability,accessibility,and quality of maternal and child health services for postpartum mothers,and their impact on satisfaction.Methods:The study utilized the Anderson model and revised the Maternal Pregnancy and Perinatal Health Service Questionnaire.A survey was conducted among 289 mothers aged 20–49 in Feicheng City.Results:Regarding accessibility,most respondents(133)reported that travel time to healthcare services exceeded 60 minutes,while 99 respondents indicated a travel time of 16–30 minutes.The issue of affordability was highlighted,with 86.85%of participants perceiving maternal healthcare services as costly,indicating a significant financial burden.More than 50%of respondents were satisfied with two specific dimensions(P<0.05)regarding the quality of maternal healthcare services.Conclusion:The study found that accessibility,affordability,and quality significantly affect mothers’satisfaction with maternal health services.Future research should focus on developing more suitable service pathways for rural mothers.

Practices of Maternity’s Care Providers in the Municipality of Kozah 1 Regarding the Administration of Vitamin K1, Eye Care, and Umbilical Cord Care in Immediate Postpartum Newborns

Background: Neonatal mortality is a real public health problem in the world and particularly in countries with limited resources. Essential care remains an effective means of reducing this mortality. Objective: To evaluate the practice of administering of vitamin K1, ocular and cord care in maternity wards in the Kozah 1 municipality. Method: This is a cross-sectional study conducted from March 1st to June 30th, 2022 in all maternity wards in the Kozah 1 municipality. Socioprofessional aspects of providers and those related to the administration of vitamin K1, ocular and cord care were studied. Results: Eighty-five (85) maternity providers were included in this study. The average age of the providers was 36.2 years with extremes of 21 and 55 years. Providers were midwives (51.8%), childbirth attendants (35.3%), and matrons (12.9%). The average length of practice was 9.5 years with extremes of 1 and 28 years. For three out of four providers (75.3%), the postpartum period was defined as a period of 02 hours following delivery. The importance of cord, ocular care, and administration of vitamin K1 in postpartum was known respectively by 84.7%, 98.8%, and 92.9% of the providers. Chlorhexidine gel was used by 81.2% of providers for umbilical cord care. For ocular disinfection, more than half of the providers (52.9%) reported using half-diluted povidone iodine. No center had displayed care protocol. Conclusion: This study highlighted the level of knowledge and practice of three essential postpartum care practices. The products used for the different care practices are consistent with recommendations but vary according to the care providers.

Thai nurses' perceptions and practices of family-centered care: The implementation gap

Objectives:This study was conducted to examine the differences between perceptions and practices of family-centered care among Thai pediatric nurses.Methods:This mixed-methods study consisted of two phases,in the first phase,a descriptive comparative design using the Family-Centered Care Questionnaire-Revised(FCCQ-R)was administered to 142 pediatric nurses from a university hospital in Bangkok,Thailand.in the second phase,qualitative interviews were conducted with 16 pediatric nurses to gather complementary information regarding the major findings from the first phase.Results:The results revealed that family strengths and individuality were rated the highest as the most important elements and the most frequent practices.Parent/professional collaboration was perceived as the least important element,while the design of the heath care delivery system was rated as the least frequent practice.The qualitative data revealed that the major reasons for suboptimal implementation included a common perception that family-centered care is a Western concept,nurses'weak attitudes towards their roles,and a shortage of nurses.Conclusions:Nurses agreed that the identified elements of family-centered care were necessary but that they did not incorporate the concepts into their daily nursing practice to maintain their endorsement of the family-centered care model.Further study is needed to explore how family-centered care is understood and operationalized by Thai nurses and how hospital administration and environments can be modified to support this care model.

System barriers to the provision of quality maternal health care in two regional teaching and referral hospitals in Kenya:a qualitative study

Objective:Sub-Saharan Africa accounts for 66%of global maternal deaths.In Kenya,362 maternal deaths occur in every 100000 live births.Most of these deaths occur as a result of suboptimal quality care of mothers during labor,delivery,or within 24h of delivery.This study explored barriers that nurse-midwives encounter in trying to provide high-quality obstetric care during these periods.Methods:A qualitative research design utilizing focus group discussion as part of a mixed method study was used to find out the participants'experiences.Data were collected between February and March 2022 in the maternity units of two regional teaching and referral hospitals in Kenya.Eligible participants were nurse-midwives in charge of the maternity unit.The discussion was conducted in English,tape-recorded,and transcribed verbatim,Data were analyzed thematically,following Braun and Clarke 6-step framework.Nvivo version 7.0 computer software was used to facilitate this process.Results:Two focused group discussions each involving seven participants were conducted.The participants agreed that maternal mortality due to postpartum hemorrhage and pregnancy-induced hypertension is a major health concern.Further,maternal care in the two hospitals was substandard.Themes that emerged as barriers were:inadequate supplies;inadequate obstetric knowledge and skills;shortage of nurse-midwives,and inadequate support supervision.The underlying factors include inadequate funding by the county government and high staff turnover.Conclusion:This study showed that nurse-midwives are working under very difficult circumstances which are hindering the provision of quality maternal care.This is mainly due to system failures and inadequate nursemidwife numbers.Targeted strategies need to be urgently implemented to mitigate these challenges to improve the quality of maternal health care.

Maternal Hospital Mortality in Cotonou: Incidence, Care-Associated Adverse Events and Causes

Introduction: Despite the many efforts made to combat preventable maternal deaths, these still remain high in Benin. It was therefore important to revisit the causes but especially the adverse events associated with care (EIS) in maternity. Objective: Determine the incidence, adverse events associated with care and causes of intra hospital maternal mortality in cotonou. Methods: This was a cross-sectional maternal mortality review study with retrospective data collection. It covered all cases of maternal death recorded between 2017 and 2021 in two (2) reference university maternities in Cotonou. Adverse events associated with care and the patient were analyzed using the maternal death audit grid validated for Benin. SPSS.26 software was used for data analysis. Results: The in-hospital maternal mortality ratio in Cotonou was 2028 maternal deaths per 100,000 live births in 2021. Only 7.2% (n = 36) of deaths were audited. The deceased mothers were 29.8 ± 7.4 years old, with no fixed monthly income in 82.7% (n = 420). Serious adverse events associated with care were: delay in decision to refer in 37% (n = 188), non-medical referral in 85.8% (n = 436) of cases, inadequate pre-referral treatment in 25.7% of cases. In receiving maternities, delay in diagnosis and inappropriate treatment at the receiving maternity were noted respectively in 22.9% and 28.6% of cases of maternal death. The direct causes of maternal death were dominated by serious obstetric hemorrhage in 43.9% (n = 223). As for the indirect causes, they were dominated by anemia excluding obstetric hemorrhages in 21.5% (n = 109). Conclusion: The in-hospital maternal mortality ratio was very high in Cotonou. The main cause was severe obstetric hemorrhage. There were several serious healthcare-associated adverse events whose correct management would significantly reduce the incidence of maternal deaths.

Women’s knowledge and preferences for midwife’s role within the range of maternal care professionals in Makkah, Saudi Arabia

Background:The midwife plays a critical role in health counselling and education,not just for women but also for their families and communities.At the current time,with the growth of the midwifery workforce globally,there is still a lack of understanding regarding the full scope and role of the midwife.Aim:To evaluate the current situation of knowledge of midwives’role among women in Makkah.In addition,this study identifies the effect of women’s knowledge on their preferences for receiving maternity care from health professionals.Methods:This study employed a descriptive quantitative cross-sectional method.The total resultant sample size(N)equalled 379 global respondents,of which 306,with a response rate=of 80.73%completed the entire survey as requested.An electronic questionnaire in the Arabic language was used in this study.Results:Results revealed that most women had incorrect knowledge regarding three aspects of the midwives’roles during pregnancy 53.9%,labour 52.8%and childbirth 61.9%.Also,results presented that most women preferred obstetricians to follow up on an uncomplicated pregnancy,labour,childbirth,and maternity care 69.6%,53.9%,64.7%and 46.1%,respectively.The study found that the women’s knowledge about midwives’roles affects their preferences for healthcare professionals in receiving maternity care(P<0.05).Conclusion:Responses showed that most participants had no experience and had negative views about midwives’roles.Thus,it would affect their health professionals’preferences for receiving maternity care.Therefore,midwifery services and maternity care professionals should prioritize educating women about midwives’competencies in maternity care.

Mistreatment during Childbirth: Impact on Maternal Outcomes and Importance of Provider Perspectives

Background: Dying in childbirth is one of the most common causes of death for women. While maternal mortality rates, defined as deaths per 100,000 live births, have been steadily dropping in most countries worldwide, maternal mortality rates have doubled in the United States in the last twenty years. This commentary examines the various contributing factors to this trend. Methods: A literature review was performed using the keywords: maternal mortality, United States, disrespectful maternity care, obstetric violence, provider perspectives, and disparities. Maternal mortality statistics were obtained from the World Health Organization website. Results: Medical factors associated with maternal mortality include increased maternal age and cardiovascular conditions. Social factors include barriers to healthcare access, delays in receiving medical care, reduction in reproductive health services in some states, and non-obstetrical deaths such as accidents, domestic violence, and suicide. Racial inequities and disparities of care are reflected in higher maternal mortality rates for minorities and people of color. Disrespectful maternity care or obstetric violence has been reported worldwide as a factor in delay of lifesaving obstetrical care and reluctance by a pregnant person to access the healthcare system. About one in five US women has reported experiencing mistreatment, varying from verbal abuse to lack of privacy, from coerced procedures to neglect during childbirth. Conclusion: This commentary highlights the importance of inclusion of providers in research on respectful maternity care. Provider burnout, moral distress, limited time, and burden of clinical responsibilities are known challenges to respectful and comprehensive medical care. The association of disrespectful care with poor maternal outcomes needs to be studied. Exploring root causes of disrespectful childbirth care can empower nurses, midwives, and physicians to improve their environment and find solutions to reduce a potential cause of maternal mortality.

Attitude toward Safety among Staffs in the Iranian Maternity Care Units of Public Hospitals with High Maternal Death Rate, 2015-2016

Background: Although extensive Mother-friendly Hospital initiatives have been improved the quality of maternity care in Iran, recent national reports have been indicated that obstetrics errors are still common. The current study aimed to assess safety attitude in the maternity care units of public hospitals in a region with high rate of maternal death in Iran. Materials and Methods: Data was collected from 314 midwives, specialist and also managers working in all public hospitals in 2016. The Cronbach’s alpha coefficient was used to analyze psychometric features of the Safety Attitudes Questionnaire (SAQ). Results: 86.2% of the participants (n = 314) completed the questionnaire. Results showed that lower scores in teamwork, safety climate and also job satisfaction subcomponents. The working conditions and stress recognition had the highest negative scores. There was a significant relationship between the following subcomponents and work load: teamwork (r = ﹣0.416, P-value = 0.05), stress recognition (r = 0.40, P-value = 0.05) and also working conditions (r = 0.421;P-value = 0.02). The score of midwives was significantly lower than specialists regarding job satisfaction (P-value = 0.014), working conditions (P-value = 0.02) and also the overall safety attitude score (P-value = 0.001). About 63% of respondents reported no error during the last year. The mean of error reporting during the last year significantly increased among specialists compared to midwives (P-value = 0.001). Conclusion: Maternity care units in the region with high maternal death have been faced with many intangible barriers related to safety attitude such as poor teamwork climate, working condition and also poor stress recognition. It is now needed to promote supportive environment for midwives and also strengthening staff cohesion through guiding the strategic direction of current maternity risk management system in creating open and just culture, improving leadership behaviors among senior managers and also addressing poor staffing levels.

Maternity or catastrophe: A study of household expenditure on maternal health care in India

Using data from 60th round of the National Sample Survey, this study attempts to measure the incidence and intensity of ‘catastrophic’ maternal health care expenditure and examines its socio-economic correlates in urban and rural areas separately. Additionally, it measures the effect of maternal health care expenditure on poverty incidence and examines the factors associated with such impoverishment due to maternal health care payments. We found that maternal health care expenditure in urban households was almost twice that of rural households. A little more than one third households suffered catastrophic payments in both urban and rural areas. Rural women from scheduled tribes (ST) had more catastrophic head counts than ST women from urban areas. On the other hand, the catastrophic head count was greater among illiterate women living in urban areas compared to those living in rural areas. After adjusting for out-of-pocket maternal health care expenditure, the poverty in urban and rural areas increased by almost equal percentage points (20% in urban areas versus 19% in rural areas). Increasing education level, higher consumption expenditure quintile and higher caste of women was associated with increasing odds of impoverishment due to maternal health care expenditure. To reduce maternal health care expenditure induced poverty, the demand-side maternal health care financing programs and policies in future should take into consideration all the costs incurred during prenatal, delivery and postnatal periods and focus not only on those women who suffered catastrophic expenditure and plunged into poverty but also those who forgo maternal health care due to their inability to pay.

Less hypoglycaemias in single room maternity care

In January 2006, the Canisius-Wilhelmina Hospital introduced the concept of Single Room Maternity Care (SMRC) by realizing 13 labour rooms for mother, infant and partner. Benefits of this new care concept not only include maternal satisfaction and increased staff satisfaction, but also significant health benefits for the neonate. Since the introduction of the concept, we registered a sharp decrease in the number of hypoglycaemias (from 15.6% in 2005 to 2.5% in 2009). Varying causes, such as successful breastfeeding and/or improved attachment between mother and infant may contribute to the decrease of hypoglycaemias.

Enablers and Barriers to Respectful Maternity Care in Low and Middle-Income Countries: A Literature Review of Qualitative Research

Background: Low and Middle-Income Countries (LMIC) account for 94% of maternal deaths annually. Interventions to reduce these deaths include;access to Emergency Obstetric Care (EmOC) and Skilled Birth Attendant (SBA) at childbirth. However, evidence indicates increasing access to EmOC, and SBA only does not translate into positive maternal and newborn outcome due to disrespectful care faced by women during labour. World Health Organization (WHO) guidelines emphasize on positive birth experience through Respectful Maternity Care (RMC). Therefore, this review aims to explore enablers and barriers to respectful maternity care in low and middle-income countries. Methods: We conducted an exhaustive literature search for studies that reported on enablers and barriers to respectful maternity care. Qualitative studies done in low and middle-income countries, published in English Language from the year 2000 to June 2020 were included in this study. Articles were screened by two researchers for eligibility and critical appraisal skills programme checklist was used to appraise the quality. The themes and quotes from the studies were extracted and synthesized using thematic synthesis. Results: The search strategy generated 14,190 articles and 54 studies met the inclusion criteria. Two main themes: interpersonal relationship and support, and privacy and confidential care were reported as both enablers and barriers to respectful maternity care. Strategies to promote RMC were: health education to pregnant women on care expected during labour, good communication between maternity staff and women, capacity building of staff on RMC and staff motivation. Conclusion: Respectful maternity care plays a big role in promoting health-seeking behaviours among pregnant women. However, women experience barriers ranging from provider behaviour, work environment and health system challenges. Ensuring a dignified and respectful working environment could contribute to an increase in health seeking-behaviours and consequently reduction of maternal mortality.

Evidence of Linkages between Patient Safety and Person-Centred Care in the Maternity and Obstetric Context—An Integrative Review

The aim was to evaluate the current state of knowledge pertaining to patient safety and its link to person-centred care. The international relevance of patient safety has expanded, as have the models of person-centred care. Inspired by this new trend, we collated and summarized the literature for evidence of the two topics. The study was guided by Russell, Whittemore and Knafl’s integrative review framework. An electronic database search was conducted for relevant articles from 2005 to 2016. This review was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. The structure and process of the evaluation of the evidence are described and the findings interpreted by means of a thematic synthesis. One theme emerged: trustful, safe communication in the relationship between the patient, family members and healthcare professionals and two domains;safety culture and multidisciplinary capacity building. The dominant dimension in the safety culture domain is respectful communication, which implies sharing experiences that lead to a sense of control during labour and birth and is related to the women’s feeling of personal capacity. The dominant dimensions in the multidisciplinary capacity building domain are collaborative teamwork, coordination and risk management, knowledge sharing and patient-centred communication. In conclusion, to enhance patient safety, it is necessary to develop patient-focused, evidence-based skills and guidelines as well as a supportive organization. Due to their interaction with patients, midwives’ communication competence on the part of midwives is essential for supporting the birth and fulfilling the women’s needs and expectations.

Women's awareness of the role of midwifes and their preference for health professionals for maternity care: a systematic review

Objective:Several studies have shown that women are more satisfied with midwife-led care.However,their awareness regarding the midwives’roles was inadequate.The effect of the women’s awareness on their preferences for maternity care from health professionals has not been understood.To identify research findings presenting women’s awareness of midwives’roles and preferences for receiving maternity care from health professionals.Methods:The systematic literature review used various electronic search engines,including SCOPUS,PubMed,ScienceDirect,and Cochrane Library.Also,other grey literature sources,including Google Scholar,were utilized to identify articles.The search included only English language articles published between 2017-2021.Results:This search provided 20 studies that fulfil the inclusion criteria and are relevant to the Population,Intervention,Comparison,and Outcomes question.The knowledge of midwives’role among the public is well studied in the literature,and few papers(4 studies)focused on women’s perceptions.The review of existing literature indicated the midwifery workforce in Arab countries like Saudi Arabia,the impact of midwives’role on maternal and child health outcomes,women’s experiences regarding midwife-led care,women’s knowledge and perception regarding the role of the midwife in maternal care,and the womens’preference for midwifes’role within the range of maternal care professionals.Conclusion:The review found a lack of awareness and knowledge among the public about the midwife’s role,particularly among women.According to evidence,women’s preferences for choosing health professionals for maternity care primarily depend on being informed about their care,being given care options,and the health professionals’comprehension of their particular care needs.

Availability and Quality of Emergency Obstetric Care, an Alternative Strategy to Reduce Maternal Mortality: Experience of Tongji Hospital, Wuhan, China

The burden of maternal mortality (MM) and morbidity is especially high in Asia.However,China has made significant progress in reducing MM over the past two decades,and hence maternal death rate has declined considerably in last decade,To analyze availability and quality of emergency obstetric care (EmOC) received by women at Tongji Hospital,Wuhan,China,this study retrospectively analyzed various pregnancy-related complications at the hospital from 2000 to 2009.Two baseline periods of equal length were used for the comparison of variables.A total of 11 223 obstetric complications leading to MM were identified on a total of 15 730 hospitalizations,either 71.35％ of all activities.No maternal death was recorded.Mean age of women was 29.31 years with a wide range of 14-52 years.About 96.26％ of women had higher levels of schooling,university degrees and above and received the education of secondary school or college.About 3.74％ received primary education at period two (P2) from 2005 to 2009,which was significantly higher than that of period one (P1) from 2000 to 2004 (P＜0.05) (OR:0.586; 95％ CI:0.442 to 0.776).About 65.69％ were employed as skilled or professional workers at P2,which was significantly higher than that of P1 (P＜0.05).About 34.31％ were unskilled workers at P2,which was significantly higher than that of P1 (P＜0.05).Caesarean section was performed for 9,930 women (88.48％) and the percentage of the procedure increased significantly from 19.25％ at P1 to 69.23％ at P2 (P＜0.05).We were led to conclude that,despite the progress,significant gaps in the performance of maternal health services between rural and urban areas remain.However,MM reduction can be achieved in China.Priorities must include,but not limited to the following:secondary healthcare development,health policy and management,strengthening primary healthcare services.

Impact of Antimicrobial Stewardship Programs on Antibiotic Use and Drug Resistance:Analysis of Data from Maternal and Child Health Care Hospitals in Hubei Province,China

ObjectiveTo evaluate the impact of Antimicrobial Stewardship Programs(ASPs)on antibiotic use and drug resistance.MethodsThis was a retrospective,multicenter,management intervention study.The data from 85 maternity hospitals(maternal and child health care hospitals)in Hubei province from 2012 to 2019 were collected.The indicators related to antimicrobial drug use included the utilization rate of different grades of antimicrobial drugs,the intensity of antimicrobial agent use,the rational use of prophylactic antimicrobial agents before class I surgical incision,and pathogenic detection and consultation rates before antimicrobial drug use.ResultsSince the implementation,the purchase of antimicrobial agents in hospitals has been maintained within the prescribed range,and the defined daily dose system(DDDs)of antimicrobial agents has been reduced,prophylactic use and accurate treatment of antimicrobial agents related to class I surgical incision have been more reasonable.With the implementation of ASPs,the detection rate of imipenem-resistant Acinetobacter baumannii,cefotaxime-resistant Escherichia coli,and methicillin-resistant Staphylococcus aureus has been decreased in China from national bacterial resistance surveillance data.ConclusionASPs have positive effects on antibiotic use and drug resistance in 85 maternity hospitals(maternal and child health care hospitals).

Investigating the Determinants of Maternal Care Services Utilization in the Brong Ahafo Region of Ghana

Ghanaian governments have made some social interventions in order to reduce risks associated with pregnancy and child delivery. However, most pregnant women do not seek maternal care. Previous studies have examined factors contributing to maternal care services utilization in Ghana using national data which limit such study applicability in some areas with specific background characteristics. These studies have mostly limited it to rural areas where the utilization is very low. This study seeks to bridge the gaps identified by exploring the factors which influence maternal care utilization in urban and rural communities in the Brong Ahafo Region of Ghana. The Chi-Square test of association and the logistic regression models are used to analyze data obtained from the 2014 Ghana Demographic and Health Survey (DHS). The data analyses were carried out using R and STATA softwares. The results revealed that women with at least 5 children were less likely (OR = 0.374, 95% CI: 0.173 - 0.796) to utilize antenatal care compared to those who had less than five live births. Educated women are three times likely (95% CI: 1.929 - 5.257) to deliver at a health facility compared to uneducated women. Women from the rich wealth quintile were nearly 16.9 times more likely (95% CI: 4.816 - 107.124) to deliver in a health facility compared to those from the poor wealth quintile. On the other hand, residing in rural communities makes it less likely (OR = 0.569, 95% CI: 0.350 - 0.913) for women to receive postnatal care within 2 months of delivery compared to living in urban communities. This study has demonstrated that maternal educational level plays a crucial role in maternal health care service utilization in the region. Therefore, government policies and programs aimed at providing more educational opportunities for girls in the region should be reinforced.

Essential Maternal and Newborn Care Skills Training for Midwives: Their Impact on Reducing Maternal and Neonatal Mortalities in Kenya

Continuing professional development (CPD) continues to gain acceptance as a model for health care professionals to engage in lifelong learning. Little is known about how CPD participants put the experience and the new knowledge into practice and whether it has impact on patient care outcomes. The primary objective of this study was to evaluate the effectiveness of CPD of Midwives on Essential Maternal and Newborn care skills on maternal and neonatal mortality in Embu County, Kenya. The study was an interventional non-randomized pretest post test study design of midwives from the participants of the 2010 ministry of health training on essential maternal and newborn care skills. Sixty (60) midwives working in maternity unit of Embu level five hospitals were targeted. The study was carried out in two phases. Phase one involved environmental scanning of the factors that support good performance in the workplace using a questionnaire. Phase two involved evaluation of the impact by testing a hypotheses using data collected by use of questionnaires, evaluation checklist and chart audit. Data were analyzed using qualitative content analysis and presented using percentages and frequency tables. Chi-square test and correlation analysis were used to show the association between variables, which are midwives essential maternal and newborn care skills and maternal and neonatal mortality. A chi-square χ2 = 14.143, df = 9 and a coefficient = 0.357. This coefficient is less than p-value at Alpha 0.05 and therefore is not significant, proving that the essential maternal and neonatal care skills do not contribute to reduction in mortalities as such two variables are almost independent of each other, whether one exists does not necessitate the existence of another nor does it reduce maternal and neonatal mortalities in Kenya.

Impact of Mobile Telephone on Maternal Health Service Care: A Case of Njoro Division

Every minute a woman dies due to pregnancy related complications globally, and half of these deaths occur in the developing countries. Despite knowing the main causes of these deaths, maternal mortality has remained high especially in Sub-Saharan Africa with 536,000 deaths annually. One of the main challenges is access to maternal health services. This study aims at assessing whether mobile telephone will improve uptake of selected maternal health services by expectant mothers at Njoro and Nessuit Health centers in Njoro Division, Nakuru. A total of 397 women were recruited between April 2012 and July 2012 and randomly categorized into two groups for follow up. One group of 191 women were routinely given prompts and advice about their health and scheduled visits while the other group of 206 women were allowed to continue with routine antenatal visits with no mobile telephone support. The results show 7.4% of those followed up had less than 4 antenatal visits while 18.6% of those not followed up had less than 4 visits P value 0.002 which shows there was a significantly higher proportion of women on follow up who had more than 4 antenatal visits. There was a significantly higher proportion of women on follow up who received diet and place of delivery counseling, malarial prophylaxis, iron and vitamin supplements and deworming drugs. There was however no difference in those who received tetanus toxoid and HIV counseling. 88.0% of the cases on follow up gave birth in a hospital as compared to 72.8% of those not on follow up with a P value of 0.000 which indicates strong association. Overall hospital delivery was 80.1% for this group a value much higher than national figures of 44%. Women provided with mobile telephone support are more likely to follow the scheduled antenatal advice and use the services as recommended than those who do not receive any support. Therefore mobile telephone should be used routinely to improve antenatal service uptake and communication with health providers.

Assessing the influence of digital technologies on antenatal care visits in Zimbabwe:insights from 2019 Zimbabwe Multiple Indicator Cluster Survey

Background and objective:To provide good health and well-being as established by the Sustainable Development Goal(SDG)3,access to digital technologies can act as conduits to achieve such progress in a population.As guided by the World Health Organization,antenatal care(ANC)attendance is one of the measures promoted to curtail the global health burden of maternal and infant mortality.ANC services are seldom utilized to their full potential in Zimbabwe.This study explores if any of the women's digital technology characteristics were associated with antenatal care visits.Methods:The study analyzed population-based cross-sectional data with a subsample of 1932 women aged 15-49 years from the 2019 Zimbabwe Multiple Indicator Cluster Survey.Test of associations with chi-square test,bivariate,and multivariate multinomial logistic regression analyses were used to examine the predictors of adequate(4-7)and optimal(≥8)ANC visits relative to undesirable(1-3)antenatal care visits among women who had given births 2 years before the survey.Results:The results indicate that 64.5%(1246/1932)of the women attained adequate ANC while about 9.8%(189/1932)attained optimal ANC.Reading a newspaper/magazine at least once a week(odds ratio[OR] 1.73,β'=0.551,t=2.030,P=0.043)and watching television at least once a week(OR 1.72,β=0.545,t=2.454,P=0.015),listening to the radio less than once a week(OR 1.28,β'=0.247,t=1.750,P=0.080),and owning a mobile phone(OR 1.48,β'=0.394,t=3.020,P=0.003)were positively associated with adequate ANC.Optimal ANC was significantly associated with women being able to read a newspaper at least once a week(OR 2.93,β'=1.074,t=3.120,P=0.002),listen to the radio less than 0nce a week(OR 2.07,p'=0.73,t=2.700,P=0.007)and have ownership of a mobile phone(OR 1.88,β'=0.631,t=2.620,P=0.009).Conclusion:Access to a newspaper,radio,television,and mobile phone were important predictors of a woman's ability to achieve her ANC attendance.Policies to improve the knowledge of ANC packages can be facilitated using digital technology to achieve adequate and preferably optimal ANC in Zimbabwe.It is important to improve digital infrastructure to support digital technologies in providing ANC services.

Maternal complications and the utilisation of maternal health care services with special reference to West Bengal, India

The study aims to examine maternal complications in the eastern states of India. Further, an attempt is also made to understand the socioeconomic factors that determine the utilization of health care services during maternity in the state of West Bengal. The data used for the study are District Level Household Survey (DLHS) 2007-08, which reveals wide regional variations in maternal complications in India. But the state of West Bengal depicts a unique picture. It has the dubious distinction of achieving low fertility and mortality with high maternal complications. The utilisation of health care services in West Bengal was never near completion. Full utilisation of ANC which is essential for safe motherhood is just above national average. A large number of deliveries still take place out of the institution and are unsafe. Analysis reveals that higher age at motherhood increases the probability of utilising maternal health care services. Social groups, years of schooling, wealth index and place of residence also show significant relationship. The findings of the study provide an insight that efforts should be made to create awareness among socially and economically disadvantaged groups of the society about the benefits of utilisation of health care services. Further it also addresses the issue of creating awareness about MDG’s.