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This paper deals with the status of antenatal care received by the Kabui Naga women of the Tamenglong district, Manipur and its impact on fertility and infant and child mortality. For this study, a cross-sectional method was adopted using purposive sampling. Data on antenatal care and health of the children were collected from a total of 434 ever-married women aged 15-49 years by using Interview Schedule. All data were managed and analyzed using SPSS 16 software by setting the level of significance at 5%. The Kabui Naga women of the Tamenglong district seldom visit health centers for the ANC check-ups due to their lack of awareness about its importance during pregnancy. The present study reveals that certain bio-social factors like improving women's education, health care practices and socio-economic status play a significant role in lowering fertility as well as infant and child mortality. Among all the independent factors considered, maternal age is significantly associated with ANC attendance. Further, in this population feeding of colostrums to the new born is found very common (97.21%). Among all the immunizations considered, the coverage of polio vaccine shows the highest followed by BCG and then measles and whooping cough respectively. [ABSTRACT FROM AUTHOR]

Antenatal care (ANC) is the largest health platform globally for delivering maternal nutrition interventions (MNIs) to pregnant women. Yet, large missed opportunities remain in nutrition service delivery. This paper examines how well evidence‐based MNIs were incorporated in national policies and programs in Bangladesh, Burkina Faso, Ethiopia and India. We compared the nutrition content of ANC protocols against global recommendations. We used survey data to elucidate the coverage of micronutrient supplementation, weight gain monitoring, dietary and breastfeeding counselling. We reviewed literature, formative research and program assessments to identify barriers and enabling factors of service provision and maternal nutrition practices. Nutrition information in national policies and protocols was often fragmented, incomplete and did not consistently follow global recommendations. Nationally representative data on MNIs in ANC was inadequate, except for iron and folic acid supplementation. Coverage data from subnational surveys showed similar patterns of strengths and weaknesses. MNI coverage was consistently lower than ANC coverage with the lowest coverage of weight gain monitoring and variable coverage of dietary and breastfeeding counselling. Key common factors associated with coverage were micronutrient supply disruptions; suboptimal counselling on maternal diet, weight gain, and breastfeeding; and limited or no record keeping. Adherence of women to micronutrient supplementation and dietary recommendations was low and associated with late and too few ANC contacts, poor maternal knowledge and self‐efficacy, and insufficient family and community support. Models of comprehensive nutrition protocols and health systems that deliver maternal nutrition services in ANC are urgently needed along with national data systems to track progress. Key points: Delivering nutrition services to all pregnant women is essential for maternal and child health outcomes but remains a challenge.Nutrition gaps in antenatal care (ANC) include lack of specificity in national guidelines and protocols, bottlenecks in micronutrient supplies, low ANC provider knowledge and skills, inadequate supervision to reinforce counseling, and not engaging families to encourage key practices.National protocols for ANC should be more specific for the four nutrition interventions (micronutrient supplements, weight gain monitoring, counseling on diets and counseling on breastfeeding) and assign accountability for coverage and quality.Country models are needed for improving provision and utilisation of nutrition interventions through ANC that are based on comprehensive policy frameworks. [ABSTRACT FROM AUTHOR]

Despite several strategies in place in South Africa and globally to prevent maternal mortality and morbidity, maternal deaths remain high, especially in sub-Saharan Africa and lower to middle-income countries. The aim of the study was to identify the challenges that lead to pregnant women's delays in seeking antenatal care (ANC) early and to find strategies to prevent such delays, contributing to a reduction of maternal deaths in South Africa. The study was conducted in two phases. Phase one analysed data on maternal deaths collected by the District Health Information System (DHIS) of the KwaZulu-Natal Department of Health from all 11 districts over a 10-year period (2009-2019). The data on maternal deaths revealed that there was a very high maternal mortality rate; between 800 and 1 780 per 100 000 live births. This correlated with very low antenatal visits; between 695-895 per 100 000 live births. In phase two, a literature review was conducted using several computer-assisted databases, bibliographies and websites to identify and source current policies. The literature review presents causes of delay in seeking ANC and strategies to prevent maternal deaths. Recommendations were made to consider strengthening education and awareness related to family planning; women empowerment through community health programmes and change in healthcare providers' behaviours and attitudes; ensuring availability of maternal health resources; and developing strategies to ensure that the ANC services delivered are in line with the South African Department of Health Guidelines. [ABSTRACT FROM AUTHOR]

Maternal health statistics have improved in many countries in sub-Saharan Africa (SSA). Still, progress remains slow in meeting the Sustainable Development Goals (SDG) targets. Accelerating antenatal care (ANC) coverage is critical to improving maternal health outcomes. To progress, countries should understand whether to target reducing health disparities between- or within-socioeconomic groups, as policies for achieving these may differ. This paper develops a framework for decomposing changes in socioeconomic inequalities in health into changes in between- and within-socioeconomic groups using the concentration index, a popular measure for assessing socioeconomic inequalities in health. It begins by noting the challenge in decomposing the concentration index into only between- and within-group components due to the possibility of an overlap created by overlapping distributions of socioeconomic status between groups. Using quantiles of socioeconomic status provides a convenient way to decompose the concentration index so that the overlap component disappears. In characterising the decomposition, a pro-poor shift occurs when socioeconomic inequality is reduced over time, including between- and within-socioeconomic groups, while a pro-rich shift or change occurs conversely. The framework is applied to data from two rounds of the Demographic and Health Survey of 19 countries in SSA conducted about ten years apart in each country. It assessed changes in socioeconomic inequalities in an indicator of at least four antenatal care visits (ANC4+) and the count of ANC visits (ANC intensity). The results show that many countries in SSA witnessed significant pro-poor shifts or reductions in socioeconomic inequalities in ANC coverage because pro-rich inequalities in ANC4+ and ANC intensity become less pro-rich. Changes in between-socioeconomic group inequalities drive the changes in ANC service coverage inequalities in all countries. Thus, policies addressing inequalities between-socioeconomic groups are vital to reducing overall disparities and closing the gap between the rich and the poor, a crucial objective for the SDGs.

Adverse pregnancy outcomes are the main causes of maternal and neonatal morbidity and mortality, including long-term physical and psychological sequelae. These events are common in low- and middle-income countries, particularly in Sub Saharan Africa, despite national efforts. Maternal infections can cause complications at any stage of pregnancy and contribute to adverse outcomes. Among infections, those of the genital tract are a major public health concern worldwide, due to limited availability of prevention, diagnosis and treatment approaches. This applies even to treatable infections and holds true especially in Sub-Saharan Africa. As late as 2017, the region accounted for 40% of all reported treatable non-viral genital pathogens worldwide, many of which have been independently associated with various adverse pregnancy outcomes, and that include Chlamydia trachomatis, Neisseria gonorrhoeae, Trichomonas vaginalis, Treponema pallidum. Two databases (PubMed and Embase) were examined to identify eligible studies published up to October 2022. This study reviewed findings on the association between infections by treatable non-viral genital pathogens during pregnancy and adverse pregnancy outcomes among women living in Sub-Saharan Africa. Articles' title and abstract were screened at first using keywords as "sexually transmitted infections", "non-viral", "adverse pregnancy outcome", "Africa", "sub-Saharan Africa", "pregnant women", "pregnancy", and "pregnancy outcome". Subsequently, according to the eligibility criteria, potential articles were read in full. Results showed that higher risk of preterm birth is associated with Treponema pallidum, Chlamydia trachomatis and Candida albicans infections. Additionally, rates of stillbirth, neonatal death, low birth weight and intrauterine growth restriction are also associated with Treponema pallidum infection. A better insight on the burden of non-viral genital pathogens and their effect on pregnancy is needed to inform antenatal care guidelines and screening programs, to guide the development of innovative diagnostic tools and other strategies to minimize transmission, and to prevent short- and long-term complications for mothers and children. [ABSTRACT FROM AUTHOR]

Background: Shortage or low-quality antenatal care is a complex and "wicked" problem relying heavily on contextual, socio-cultural, environmental and intersectional aspects. We report the outcome of an expert consultation discussing solutions to improve antenatal care quality, access and delivery in low- and middle-income countries, and providing recommendations for implementation.Methods: The social ecological model was used as an analytical lens to map and interpret discussion points and proposed solutions. In addition, a conceptual framework for maternal and neonatal health innovation based on the building blocks of the World Health Organization health system and the Tanahashi Health Systems Performance Model provided a logical overview of discussed solutions.Results: Many barriers and norms continue to hinder antenatal care access. From values, beliefs, traditions, customs and norms, to poor resource allocation, there is a need of reshaping health systems in order to provide high quality, respectful maternal and childcare. The burden of poor maternal health, morbidity and mortality is concentrated among populations who are vulnerable due to gender and other types of discrimination, have financial constraints and are affected by humanitarian crises.Conclusions: In order to address maternal health issues, good quality and evidence-based services should be guaranteed. Investments in strengthening health systems, including data and surveillance systems and skilled health workforce, should be considered an essential step towards improving maternal health services. [ABSTRACT FROM AUTHOR]

Abstract Antenatal care (ANC) is the largest health platform globally for delivering maternal nutrition interventions (MNIs) to pregnant women. Yet, large missed opportunities remain in nutrition service delivery. This paper examines how well evidence‐based MNIs were incorporated in national policies and programs in Bangladesh, Burkina Faso, Ethiopia and India. We compared the nutrition content of ANC protocols against global recommendations. We used survey data to elucidate the coverage of micronutrient supplementation, weight gain monitoring, dietary and breastfeeding counselling. We reviewed literature, formative research and program assessments to identify barriers and enabling factors of service provision and maternal nutrition practices. Nutrition information in national policies and protocols was often fragmented, incomplete and did not consistently follow global recommendations. Nationally representative data on MNIs in ANC was inadequate, except for iron and folic acid supplementation. Coverage data from subnational surveys showed similar patterns of strengths and weaknesses. MNI coverage was consistently lower than ANC coverage with the lowest coverage of weight gain monitoring and variable coverage of dietary and breastfeeding counselling. Key common factors associated with coverage were micronutrient supply disruptions; suboptimal counselling on maternal diet, weight gain, and breastfeeding; and limited or no record keeping. Adherence of women to micronutrient supplementation and dietary recommendations was low and associated with late and too few ANC contacts, poor maternal knowledge and self‐efficacy, and insufficient family and community support. Models of comprehensive nutrition protocols and health systems that deliver maternal nutrition services in ANC are urgently needed along with national data systems to track progress.

Background: Skin-to-skin contact (SSC) practice improves newborn survival and child development through preventing hypothermia in newborns, improving early initiation of breastfeeding practice, and strengthening mother-child bonding. Despite having numerous benefits, it is one of the least practiced interventions in low and middle-income countries (1 to 74%). In Bangladesh, the prevalence of SSC was 26% in 2014. In this study, we aimed to estimate the prevalence of SSC in the study districts and identify factors that facilitate or inhibit SSC practice so that context-specific recommendations can be made to advance the use of this intervention.Methods: We used baseline household survey data of USAID's MaMoni MNCSP project conducted in 10 districts of Bangladesh in 2019. Our analysis included 13,695 recently delivered women (RDW) with a live birth outcome. Our primary outcome was the mother's reported practice of SSC. We examined various antepartum, intrapartum, newborn, and sociodemographic factors associated with SSC using a multivariable generalized linear model. Our findings were reported using adjusted Prevalence Risk Ratios (aPRRs) and 95% Confidence Intervals (CIs).Results: Overall, 28% of RDW reported practicing SSC across the 10 surveyed districts. Our multivariable analysis showed that public facility delivery (aPRR 2.01; 95%CI: 1.80, 2.26), private facility delivery (aPRR 1.23; 95%CI: 1.06, 1.42) and ≥ 4 antenatal care (ANC) visits at least one from a medically trained provider (MTP) (aPRR 1.17; 95%CI: 1.03, 1.26) had a significant positive association with SSC practice. Caesarean section (aPRR 0.64; 95%CI: 0.56, 0.73) had a significant negative association with SSC practice compared to vaginal births. We also found a significant positive association of SSC practice with mothers' who perceived the birth size of their baby to be small, mothers with a higher education level (≥10 years), and mothers from households in the highest wealth quintile.Conclusions: The prevalence of SSC is very low in the surveyed districts of Bangladesh. Considering the factors associated with SSC, relevant stakeholders need to increase their efforts on improving ANC and facility delivery coverages as well as improving SSC practice in the facilities especially after caesarean deliveries. Countries with a high burden of home deliveries, also need to emphasize community-based interventions and increasing coverage of skilled birth attendance for improving this life-saving intervention. [ABSTRACT FROM AUTHOR]

Low birthweight (LBW) is a serious public health problem in lower-middle income countries. Despite several efforts have been made to improve the utilization of maternal health care, universalization of antenatal care (ANC) remains a major challenge in India. This paper aims to examine the association between the use of ANC services and LBW in India. A cross-sectional observational study was carried out using the data from the 2015 to 2016 National Family Health Survey (n = 147,762). We have carried out bivariate and multivariate analyses to fulfil the objective of this study. About 18% of the sample children were born with LBW. Only ¼th last birth women received full ANC services in 2015–2016. The results of binary logistic regression indicate that the likelihood of LBW was significantly lower among those children whose mother have adequate ANC services compared to those mother who did not receive those services even after accounting for important socioeconomic and demographic factors. The findings of this study suggest that providing affordable and quality ANC services could be an effective strategy to reduce the incidence of LBW. Furthermore, targeted invention is needed among socioeconomically vulnerable women to improve the utilization of ANC services, which could combat the incidence of LBW. • This study assesses the association between antenatal care (ANC) utilization and low birthweight (LBW) in India. • LBW is a serious public health problem in lower-middle income countries, associated with several adverse outcomes. • Adequate utilization of ANC services has significant negative association with LBW of children. • Providing affordable and quality ANC services could be an effective strategy to reduce the incidence of LBW. [ABSTRACT FROM AUTHOR]

Electronic Integrated Antenatal Care (e-iANC) was built as a web-based application to assist midwives in recording Antenatal Care (ANC) data including Patient Registration; Anamnesis; Physical Examination; Laboratory Test, Screening of Risk Pregnancy; Communication, Information and Education; Treatment and follow-up; Patient Disposition. To ensure e-iANC becomes a safe system, security system testing was needed. Our goals were to test the security system by using the Open Web Application Security Project (OWASP). It was conducted in computer laboratory at Universitas Esa Unggul Jakarta in August 2017. The OWASP detect include Injection, Broken Authentication and Session Management, Cross-Site Scripting (XSS), Insecure Direct Object References, Security Misconfiguration, Sensitive Data Exposure, Missing Level Access Control, Cross Site Request Forgery (CSRF), Using Known Vulnerable Components, Unvalidated Redirects and Forwards. The results indicated the risk level of e-iANC was the low category in the aspect of Cross-Domain JavaScript Source File Inclusion, Private IP Disclosure, XSS Protection Not Enabled Web Browser. [ABSTRACT FROM AUTHOR]

'Medical pluralism' is the use of multiple health systems and is common among people living with HIV/AIDS in sub-Saharan Africa. Healers and traditional birth attendants (TBAs) often are a patient's first and/or preferred line of treatment; this often results in delayed, interrupted, or abandoned diagnosis and therapy. Literature from the study of medical pluralism suggests that HIV care and treatment programs are infrequently and inconsistently engaging healers around the world. Mistrust and misunderstanding among patients, clinical providers, and traditional practitioners make the development of effective partnerships difficult, particularly regarding early HIV diagnosis and antiretroviral therapy. We provide recommendations for the development of successful collaboration health workforce efforts based on both published articles and case studies from our work in rural Mozambique. [ABSTRACT FROM AUTHOR]

Background: Interventions for curing most diseases and save lives of pregnant and delivering women exist, yet the power of health systems to deliver them to those in most need is not sufficient. The aims of this study were to design a participatory antenatal care (ANC) strengthening intervention and assess the implementation process and effectiveness on quality of ANC in Jimma, Ethiopia. Methods: The intervention comprised trainings, supervisions, equipment, development of health education material, and adaption of guidelines. It was implemented at public facilities and control sites were included in the evaluation. Improved content of care (physical examinations, laboratory testing, tetanus toxoid (TT)-immunization, health education, conduct of health professionals, and waiting time) were defined as proximal project outcomes and increased quality of care (better identification of health problems and increased overall user satisfaction with ANC) were distal project outcomes. The process of implementation was documented in monthly supervision reports. Household surveys, before (2008) and after (2010) intervention, were conducted amongst all women who had given birth within the previous 12 months. The effect of the intervention was assessed by comparing the change in quality of care from before to after the intervention period at intervention sites, relative to control sites, using logistic mixed effect regression. Results: The continued attention to the ANC provision during implementation stimulated increased priority of ANC among health care providers. The organizational structure of the facilities and lack of continuity in care provision turned out to be a major challenge for implementation. There was a positive effect of the intervention on health education on danger signs during pregnancy (OR: 3.9, 95% CI: 2.6;5.7), laboratory testing (OR for blood tests other than HIV 2.9, 95% CI: 1.9;4.5), health problem identification (OR 1.8, 95% CI: 1.1;3.1), and satisfaction with the service (OR: 0.4, 95% CI: 0.2;0.9). There was no effect of intervention on conduct of health professionals. The effect of intervention on various outcomes was significantly modified by maternal education. Conclusion: The quality of care can be improved in some important aspects with limited resources. Moreover, the study provides strategic perspectives on how to facilitate improved quality of ANC. [ABSTRACT FROM AUTHOR]

Four northern states of India – Bihar, Madhya Pradesh, Rajasthan and Uttar Pradesh – lag far behind the other states of the country regarding demographic transition and socio-economic development. The study described in this article shows the utilization of child immunization services in these states, utilizing data from the National Family Health Survey, India, 1992–3 (IIPS, 1995a, 1995b, 1995c) The study used multivariate logistic regression to correlate the utilization of child immunization. The results showed that children are more likely to receiveimmunization if their parents are a couple, with the father literate andthe mother with at least a middle-school-education level who received antenatal care or delivered in an institutional environment. [ABSTRACT FROM PUBLISHER]