Mapping the quality of prenatal and postnatal care and demographic differences on child mortality in 26 low to middle-income countries

Background Closing the gap between child mortality in low-and middle-income countries(LMICs)and high-income countries is a priority set by the WHO in sustainable development goals(SDGs).We aimed to examine poor nutrition and prenatal and postnatal care that could increase the risk of child mortality in LMICs.Methods The Demographic and Health Survey(DHS)was used to examine data from 26 countries to compare prenatal,postnatal,nutritional,and demographic factors across LMICs.Outcome of child death was classified into death before one month of age,between 1 to 11 months,between one to two years,between three to five years,and overall death before five years.Chi-square analyses identified differences in prenatal care,postnatal care,nutrition,and demographic factors between children who died and those who survived.Logistic regression identified factors that increased child mortality risk.Results The majority of deaths occurred before the ages of one month and one year.Considerably poorer quality of prenatal care,postnatal care,and nutrition were found in low-income and low-middle-income countries in the contemporary 2020s.High child mortality and poor quality of prenatal and postnatal care coincide with low income.Children in LMICs were exposed to less vitamin A-rich foods than children in higher-middle-income countries.The use of intestinal parasite drugs and the absence of postpartum maternal vitamin A supplementation significantly increased child mortality risk.Significant socio-demographic risk factors were associated with an increased mortality rate in children,including lack of education,maternal marital status,family wealth index,living rurally,and financial problems hindering access to healthcare.Conclusions Poor nutrition remains a vital factor across all LMICs,with numerous children being exposed to foods low in iron and vitamin A.Significantly,most deaths occur in neonates and infants,indicating an urgent need to address risk factors associated with early child death.

Benefits of and Barriers to Male Involvement in Maternal Health Care in Ibanda District, Southwestern, Uganda

Background: Male involvement in reproductive health care has been shown to have positive outcomes on the maternal and newborn’s health as they provide resources and make crucial decisions. However, male involvement in reproductive/maternal health care in Uganda is still low. The objective of this study was to explore community perspectives on benefits and barriers to men’s involvement in maternity care in southwestern Uganda. Methods: The study was a cross-sectional, exploratory study, in Ibanda district, southwestern Uganda Data collection was collected in May 2020, using qualitative methods, narrative interviews and analyzed using a content-based approach. The sampling was done purposively and 18 narrative interviews were conducted. Results: Eighteen (18) narrative interviews were conducted at households of the participants. The identified benefits of male’s involvement in reproductive care services included family wellbeing and health, health care services utilization, health care worker motivation and community improvement and development. The barriers that emerged included individual and behavioral factors like ignorance/knowledge, responsibility, excessive alcohol consumption, laziness and lack of money. Family and extended family factors included trust and cooperation by the couple, fidelity issues, domestic violence and family perceptions. The environment, cultural and gender factors like misperceptions of male involvement, the cultural beliefs about the role of men in reproductive issues and the gender norms. The health care services factors included timing of the services the attitude of the health workers and the availability and access to the health services. Conclusions: The benefits of male involvement in maternal health care include family wellbeing and health, health care services utilization, health worker motivation and community improvement and prosperity. The barriers to male involvement in antenatal, delivery and postnatal care include individual and behavioral, family and extended family, environmental, cultural and gender and health care services factors. Therefore interventions to improve male involvement should focus on the individual, family, cultural, gender and health care services factors.

Implementation and Evaluation of a Postpartum Care Program for Mothers Raising Infants: A Pilot Study

Background: The aims of this pilot study were to implement and evaluate a postpartum care program for mothers raising children younger than one year to provide physical relaxation, and to reduce mothers’ parenting problems. Methods: A day-service and group-type postpartum care program was implemented with the aim of interacting with peers, promoting local communication, and relaxing mothers. Results: Forty-five pairs of mothers and infants participated in the study. Most of the mothers experienced relaxation, communicated with each other, resolved physical problems, reduced childcare concerns, and developed parenting friends. Conclusions: In addition, feasibility was assured as they were very satisfied with the content of programs such as baby massage and aroma treatment.

Effects of Prenatal Perineal Massage and Kegel Exercises on the Integrity of Postnatal Perine

Aim: This randomize controlled experimental study has been carried out to investigate the effects on the integrity of perine of perineal massage and Kegel exercises applied prenatally to women who experienced vaginal delivery. Methods: Research was carried out between January 2012 and 2013, with a total of 101 pregnant women who referred to Ege University Hospital in ?zmir. Data Collection Form, Kegel Exercise Training Brochure, Practice Observation Form and Prenatal Perinea Massage Learning Guide for Implementer were used. Researcher continued to perform this massage once a week until delivery. Kegel exercises were asked to perform exercises at home and also to register them until delivery. When exercise group came to weekly controls or when they were contacted at home they were asked if they have performed daily exercise or not. The pregnant women in control group did not receive any application. One to one interview was performed during delivery and postnatal 24 hours at the hospital and a telephone interview was performed 15 days postnatal, so three groups were evaluated. The chi-square, Mann-Whitney U test and Kruskal Wallis test were used. Results: A statistically significant difference was found between study and control groups in terms of episiotomy rates, laceration, postnatal 24 hours and 15 days perineal pain and improvement (p < 0.05). Conclusion: It was found that perineal massage and Kegel exercises are important in maintaining the integrity of perineal significantly. It is thought that when the perineal massage and Kegel exercise being performed during pregnancy is supported by health professional, it will play a significant role in women’s quality of life.

Determination of Level of Knowledge on Modern Methods of Family Planning among Women of Reproductive Age (18 - 49 Years) at Mathare North Health Center in Nairobi County, Kenya

Introduction: Modern family planning methods (MFPM) prevent unwanted pregnancies, reduce fertility rate, and increase the interval between pregnancies. They prevent pregnancy by preventing fertilization or implantation of the fertilized ovum. MFPM include tubal ligation (TL), vasectomy, oral contraceptive pills, the intrauterine contraceptive device (IUCD), depot injections, sub-dermal implants, and male and female condoms. Objective: To determine the level of knowledge of modern family planning methods (MFPM) among women of reproductive age (18 - 49 years) at the Mathari North Health Center in Nairobi County, Kenya. Methods: The study conducted among women of reproductive age at Mathare North Health Center in Nairobi was a cross-sectional descriptive survey between March 2016 and November 2018. It provided both qualitative and quantitative data. The sample size comprised of 274 women of reproductive age, i.e. (18 - 49 years) attending antenatal and postnatal clinics at the facility. Those excluded were women below 18 years of age, as they could not give consent according to Kenyan Laws. The data were collected using an interviewer-administered structured questionnaire, which consisted of socio-demographic and characteristics, knowledge of modern family planning methods and distance from the facility. Likert scale was used to ensure that data was tabulated on daily basis and subjected to statistical manipulation using Statistical Package for Social Sciences (SPSS). Results: The four leading MFPM in use in order of acceptability were injectables, implants, intrauterine contraceptive device and pills in that order. 91% of respondents were aware or had heard about modern family planning methods. Level of education of mother and father were the two variables that influenced the uptake of MFPM with p-values of 0.0260 and 0.025, respectively. The study further found that knowledge of MFPM had a significant influence on their assimilation and utilization. All secondary variables considered in the research exhibit a substantial relationship concerning the use of MFPM. Conclusion: Communities around Mathari North Health Center need to be given information;education and counselling on MFPM to enable them make an informed decision and choice on their preferred method of family planning.

Incidence and Risk Factors of Obstetric Anal Sphincter Injuries after Various Modes of Vaginal Deliveries in Chinese Women

Background： Obstetric anal sphincter injuries （OASIS） can cause an adverse impact on women＇s physical and mental health. There was lack of published data in Chinese population particularly on studying the risk of OASIS for nonrotational outlet forceps. This study was to determine the incidence and risk factors of OASIS. Methods： This is a retrospective cohort study carried out in a tertiary referral hospital in Hong Kong. The control group was selected randomly. Univariate and multivariate logistic regression analysis was performed to evaluate the influence of potential risk factors on OASIS. This study reviewed the obstetric records of OASIS women and random control from January 2011 to June 2014. Univariate and multivariate logistic regression analysis was performed to evaluate the influence of potential risk factors on OASIS. Results： Of 15,446 women delivered, 49 had OASIS. The percentage of OASIS increased from 0.3% （2011） to 0.38% （2014）. There was an increasing trend of OASIS in attempted spontaneous vaginal delivery without episiotorny （P 〈 0.01）~ but it did not increase the OASIS risk （P = 0.46）. Univariate analysis of 49 cases and 438 control subjects showed that forceps delivery （odds ratio [OR] -8.73, P 〈 0.01 ）, prolong second stage of labor （OR = 1.43, P 〈 0.01） increased the risk lbr OASIS. In multivariate regression models, only lbrceps delivery （OR = 6.28, P 〈 0.01） proved to be independent risk factor. Conclusions： The incidence of OASIS in Chinese women was increased alter 2012, but still lower than the reported figures in the literature. Outlet forceps delivery could be a possible associated risk factor.