Male partners involvement in their wives' antenatal care and its associated factors in southern Ethiopia. A community-based cross-sectional study.

Background: Involvement of male partners in antenatal care (ANC) is an effective approach to improve maternal and child health outcomes. It also enhances maternal healthcare utilization as males prevails decision-making regarding healthcare utilization in most developing countries including Ethiopia. Despite the acknowledged importance of male partners involvement, there is no research data in the study area. Therefore, the purpose of this study is to assess the status of male partners' involvement in antenatal care and associated factors in Chencha town, which is found in southern region of Ethiopia. Methods: The study adopted a community-based cross-sectional design from April 1-30, 2022, among 560 male partners in Chencha Town. To collect data, we use a structured, pretested and interviewer-administered questionnaire. The study participants were selected using a simple random sampling method. Analysis of data was performed using the statistical package for social sciences (SPSS) version 25. Descriptive statistics including mean, frequency, and percentage were used to summarize pertinent characteristics of study participants. Both bivariable and multivariable logistic regression analyses were carried out to detect the association between the independent and outcome variables. The statistical significance was set at P < 0.05 in the final model. Result: The study found that 57% (95% CI: 53%-61%) of male partners were involved in antenatal care. Age 20 to 29 (AOR = 2.60, 95%CI:1.26, 5.37), more than secondary educational level (AOR = 2.04, 95%CI:1.08, 3.88), being government workers (AOR = 2.03, 95%CI:1.12, 3.67), exposure to information on male involvement during antenatal care (AOR = 4.37, 95%CI: 2.77, 6.91), and males' knowledge about pregnancy danger sign (AOR = 2.55, 95%CI: 1.62, 4.02) were factors positively associated with male partner involvement in antenatal care. Conclusion: The prevalence of male partner involvement in antenatal care was relatively high, but it still needs to be improved to reach acceptable level. The involvement thrives among those aged 20-29 years, who have been exposed to information on male involvement in antenatal care, have higher education levels, government employees, and are aware of pregnancy danger signs. These factors can be used to target interventions that aim to increase male involvement in antenatal care, which helps to improve the health of both mothers and children.

Antenatal Care Utilisation among Adolescent Mothers in Ngozi Province, Burundi.

Background: Globally pregnancy and childbirth complications are the leading cause of death among adolescents, with evidence showing that antenatal care (ANC) is a very effective preventive intervention. In Burundi, there is limited information on the extent to which pregnant adolescents utilise such services. Objective: To assess the ANC utilisation and factors associated with its use among adolescent mothers in Ngozi Province, Burundi. Materials and Methods: A cross-sectional, health facility-based study among 216 adolescent mothers who had given birth within two years preceding this study, using structured questionnaires and records from previous ANC booklets. A multistage random sampling technique was used to select respondents while the utilisation of ANC was determined by the frequency of ANC visits and the time when the women enrolled for the first ANC visit. Results: The majority (98.1%) of adolescent mothers in Ngozi Province used ANC services. Most respondents (64.8%) initiated ANC services within the first trimester while 57.8% attained the minimum of four recommended ANC visits. Marital status (P = 0.001), geographical location (P = 0.009), occupation of the partner (P = 0.002) and type of the last pregnancy (P = 0.012) were associated with ANC initiation within the first trimester while marital status (P < 0.001), respondent's employment (P = 0.003) and type of last pregnancy (P < 0.001) were associated with appropriate ANC frequency. Conclusion: This study revealed a high use of ANC services among adolescent mothers, although more than one-third attended ANC late. There is therefore the need to put more effort into improving early booking for ANC.

Has the Gratuité policy reduced inequities in geographic access to antenatal care in Burkina Faso? Evidence from facility-based data from 2014 to 2022.

Background: Evidence shows that user fee exemption policies improve the use of maternal, newborn, and child health (MNCH) services. However, addressing the cost of care is only one barrier to accessing MNCH services. Poor geographic accessibility relating to distance is another. Our objective in this study was to assess the effect of a user fee exemption policy in Burkina Faso (Gratuité) on antenatal care (ANC) use, considering distance to health facilities. Methods: We conducted a cross-sectional study with sub-analysis by intervention period to compare utilization of ANC services (outcome of interest) in pregnant women who used the service in the context of the Gratuité user fee exemption policy and those who did not, in Manga district, Burkina Faso. Dependent variables included were socio-demographic characteristics, obstetric history, and distance to the lower-level health facility (known as Centre de Santé et Promotion Sociale) in which care was sort. Univariate, bivariate, and multivariate analyses were performed across the entire population, within those who used ANC before the policy and after its inception. Results: For women who used services before the Gratuité policy was introduced, those living 5-9 km were almost twice (OR = 1.94; 95% CI: 1.17-3.21) more likely to have their first ANC visit (ANC1) in the first trimester compared to those living <5 km of the nearest health facility. After the policy was introduced, women living 5-9 km and >10 km from the nearest facility were almost twice (OR = 1.86; 95% CI: 1.14-3.05) and over twice (OR = 2.04; 95% CI: 1.20-3.48) more likely respectively to use ANC1 in the first trimester compared to those living within 5 km of the nearest health facility. Also, women living over 10 km from the nearest facility were 1.29 times (OR = 1.29; 95% CI: 1.00-1.66) more likely to have 4+ ANC than those living less than 5 km from the nearest health facility. Conclusions: Insofar as the financial barrier to ANC has been lifted and the geographical barrier reduced for the populations that live farther away from services through the Gratuité policy, then the Burkinabé government must make efforts to sustain the policy and ensure that benefits of the policy reach the targeted and its gains maximized.

Do tuition-free lower secondary education policies matter for antenatal care among women in sub-saharan African countries?

BACKGROUND: Antenatal care (ANC) is critical to reducing maternal and infant mortality. However, sub-Saharan Africa (SSA) continues to have among the lowest levels of ANC receipt globally, with half of mothers not meeting the WHO minimum recommendation of at least four visits. Increasing ANC coverage will require not only directly reducing geographic and financial barriers to care but also addressing the social determinants of health that shape access. Among those with the greatest potential for impact is maternal education: past research has documented a relationship between higher educational attainment and antenatal healthcare access, as well as related outcomes like health literacy and autonomy in health decision-making. Yet little causal evidence exists about whether changing educational policies can improve ANC coverage. This study fills this research gap by investigating the impact of national-level policies that eliminate tuition fees for lower secondary education in SSA on the number of ANC visits. METHODS: To estimate the effect of women's exposure to tuition-free education policies at the primary and lower secondary levels on their ANC visits, a difference-in-difference methodology was employed. This analysis leverages the variation in the timing of education policies across nine SSA countries. RESULTS: Exposure to tuition-free primary and lower secondary education is associated with improvements in the number of ANC visits, increasing the share of women meeting the WHO recommendation of at least four ANC visits by 6-14%. Moreover, the impact of both education policies combined is greater than that of tuition-free primary education alone. However, the effects vary across individual treatment countries, suggesting the need for further investigation into country-specific dynamics. CONCLUSIONS: The findings of this study have significant implications for policymakers and stakeholders seeking to improve ANC coverage. Removing the tuition barrier at the secondary level has shown to be a powerful strategy for advancing health outcomes and educational attainment. As governments across Africa consider eliminating tuition fees at the secondary level, this study provides valuable evidence about the impacts on reproductive health outcomes. While investing in free education requires initial investment, the long-term benefits for both human development and economic growth far outweigh the costs.

Determinants of externally visible birth defects among perinatal deaths at Adama Comprehensive Specialized Hospital: a case-control study.

BACKGROUND: Birth defects (BDs) are the major causes of infant morbidity and mortality in both developed and developing countries. Regardless of their clinical importance, few studies on predisposing factors have been conducted in Ethiopia. However, due to a lack of advanced diagnostic materials, we only considered the externally visible BDs. OBJECTIVE: To assess the determinants of externally visible birth defects among perinatal deaths at Adama Comprehensive Specialized Hospital. METHODS: A retrospective unmatched case-control study design was conducted from November 01 to 30, 2021. The sample size was determined by Epi Info version 7 software considering sample size calculation for an unmatched case-control study. A total of 315 participants (63 cases, and 252 controls) were selected by simple random sampling. Data were collected by an open data kit (ODK) and transported to a statical package for social sciences (SPSS) version 26 software for analysis. The bivariate followed by multivariable logistic regression analyses were done to determine the factors associated with the BD. RESULTS: This study showed that drinking alcohol during pregnancy (AOR = 6.575; 95% CI: 3.102,13.937), lack of antenatal care (ANC) follow-up during pregnancy (AOR = 2.794; 95% CI: 1.333, 5.859), having a history of stillbirth in a previous pregnancy (AOR = 3.967; 95% CI: 1.772, 8.881), exposure to pesticides during pregnancy (AOR = 4.840; 95% CI: 1.375, 17.034), having a history of BDs in a previous pregnancy (AOR = 4.853; 95% CI: 1.492, 15.788), and lack of folic acid supplementation during early pregnancy (AOR = 4.324; 95% CI: 2.062, 9.067) were significant determinants of externally visible BDs among perinatal deaths. CONCLUSION: In this study, alcohol use, exposure to pesticides, and lack of folic acid supplementation during pregnancy were identified as the major determinants of externally visible BDs among perinatal deaths. Thus, health education regarding the associated factors of BDs and their preventive strategies should be given to pregnant mothers.

Availability and readiness of healthcare facilities and their effects on antenatal care services uptake in Bangladesh.

BACKGROUND: Sustainable Development Goal (SDG) 3.7 aims to ensure universal access to sexual and reproductive healthcare services, where antenatal care (ANC) is a core component. This study aimed to examine the influence of health facility availability and readiness on the uptake of four or more ANC visits in Bangladesh. METHODS: The 2017/18 Bangladesh Demographic and Health Survey data were linked with the 2017 Health Facility Survey and analyzed in this study. The associations of health facility-level factors with the recommended number of ANC uptakes were determined. A multilevel mixed-effect logistic regression model was used to determine the association, adjusting for potential confounders. RESULTS: Nearly 44% of mothers reported four or more ANC uptakes, with significant variations across several areas in Bangladesh. The average distance of mothers' homes from the nearest health facilities was 6.36 km, higher in Sylhet division (8.25 km) and lower in Dhaka division (4.45 km). The overall uptake of the recommended number of ANC visits was positively associated with higher scores for the management (adjusted odds ratio (aOR) 1.85; 95% CI, 1.16-2.82) and infrastructure (aOR, 1.59; 95% CI, 1.09-2.19) of health facilities closest to mothers' homes. The odds of using the recommended number of ANC in mothers increased by 3.02 (95% CI, 2.01-4.19) and 2.36 (95% CI, 2.09-3.16) folds for each unit increase in the availability and readiness scores to provide ANC services at the closest health facilities, respectively. Every kilometer increase in the average regional-level distance between mothers' homes and the nearest health facilities reduced the likelihood of receiving the recommended number of ANC visits by nearly 42% (aOR, 0.58, 95% CI, 0.42-0.74). CONCLUSION: The availability of healthcare facilities close to residence, as well as their improved management, infrastructure, and readiness to provide ANC, plays a crucial role in increasing ANC services uptake. Policies and programs should prioritize increasing the availability, accessibility, and readiness of health facilities to provide ANC services.

The impact of the COVID-19 pandemic on reproductive, maternal, neonatal, and child health care services in Kiambu County, Kenya.

The global response to COVID-19 undermined established public health goals. This study investigated the impact of COVID-19 on reproductive, maternal, neonatal, and child health (RMNCH) services in Kiambu County, Kenya. It was a retrospective cross-sectional study, where data on antenatal care (ANC), delivery, postnatal care (PNC), and family planning (FP) before and after COVID-19 was retrieved and compared. New ANC clients and 4th ANC visits decreased by 2.9% and 17% respectively. New clients attending PNC increased by 13.3% (p = 0.007). Skilled deliveries reduced by 0.3%, maternal, neonatal deaths, and fresh stillbirths reduced by 0.7%, 23.9%, and 15.8% respectively. Caesarean sections rose by 12.7% (p=0.001). New clients and revisits for family planning reduced by 15.4% and 6.6% respectively. The pandemic adversely affected most of the RMNCH services. There is a need for health departments to institute robust strategies to recover the gains lost during COVID-19.

La réponse mondiale à la COVID-19 a sapé les objectifs de santé publique établis. Cette étude a examiné l'impact du COVID-19 sur les services de santé reproductive, maternelle, néonatale et infantile (SRMNI) dans le comté de Kiambu, au Kenya. Il s'agissait d'une étude transversale rétrospective, dans laquelle les données sur les soins prénatals (ANC), l'accouchement, les soins postnatals (PNC) et la planification familiale (PF) avant et après la COVID-19 ont été récupérées et comparées. Les nouvelles clientes de CPN et les 4èmes visites de CPN ont diminué respectivement de 2,9 % et 17 %. Les nouveaux clients fréquentant la PNC ont augmenté de 13,3 % (p = 0,007). Les accouchements qualifiés ont diminué de 0,3 %, les décès maternels et néonatals et les nouvelles mortinaissances ont diminué respectivement de 0,7 %, 23,9 % et 15,8 %. Les césariennes ont augmenté de 12,7 % (p=0,001). Les nouveaux clients et les nouvelles visites pour la planification familiale ont diminué respectivement de 15,4% et 6,6%. La pandémie a eu des conséquences néfastes sur la plupart des services de RMNCH. Il est nécessaire que les services de santé mettent en place des stratégies solides pour récupérer les gains perdus pendant la COVID-19.

Implementation and evaluation of the centering pregnancy group prenatal care model in pregnant women with diabetes: a convergent parallel mixed methods study protocol.

BACKGROUND: Diabetes during pregnancy has negative effects on both mothers and their fetuses. To improve perinatal outcomes and women's experience of care, the World Health Organization (WHO) suggests implementing health system interventions to enhance the use and quality of antenatal care. The main goal of this study is to implement and evaluate the outcomes of the Centering Pregnancy group care model for pregnant women with diabetes. METHODS/DESIGN: The study will consist of three phases: a quantitative phase, a qualitative phase, and a mixed phase. In the quantitative phase, a randomized controlled trial will be conducted on 100 pregnant women with diabetes receiving prenatal care in Tabriz City, Iran. The Summary of Diabetes Self-Care Activities (SDSCA) questionnaire will also be validated in this phase. The qualitative phase will use qualitative content analysis with in-depth and semi-structured individual interviews to explore pregnant women's understanding of the impact of the Centering Pregnancy group care model on their care process. The mixed phase will focus on the degree and extent of convergence between quantitative and qualitative data. DISCUSSION: The implementation of the Centering Pregnancy group care approach is anticipated to empower women in effectively managing their diabetes during pregnancy, resulting in improved outcomes for both mothers and newborns. Furthermore, adopting this approach has the potential to alleviate the financial burden of diabetes on healthcare system. TRIAL REGISTRATION: Iranian Registry of Clinical Trials (IRCT): (IRCT20120718010324N80/ Date of registration: 2024-01-03). URL: https://irct.behdasht.gov.ir/trial/74206 .

Diabetes during pregnancy, whether pre-existing or gestational, can lead to complications for both the mother and the baby. Gestational diabetes is common and poses risks such as preterm birth and cesarean delivery. Pre-existing diabetes is on the rise globally and increases the likelihood of adverse outcomes like fetal death and birth defects. Centering Pregnancy is a group-based prenatal care model that offers comprehensive care to women with similar gestational ages. It promotes behavior modification, social support, and knowledge exchange among participants. However, there is limited research on the effectiveness of this model specifically for women with diabetes, especially in Iran.To address this research gap, the study aims to implement and evaluate the Centering Pregnancy model in pregnant women with diabetes in Iran. By employing a combined methodology, the researchers will assess the current state of care and gather comprehensive data to understand the impact of the model. The findings of this study can contribute to improving the healthcare system's burden and enhancing self-care practices for pregnant women with diabetes, ultimately leading to better pregnancy experiences and improved maternal and neonatal outcomes.

Determinants of early antenatal care visits among women of reproductive age in Ghana: evidence from the recent Maternal Health Survey.

BACKGROUND: Antenatal care services play a crucial role in promoting positive pregnancy outcomes by facilitating the early identification of pregnancy risk factors and early diagnosis of pregnancy-related complications. This study aimed to assess the frequency and timing of ANC attendance of mothers in Ghana as well as determine the predictors of early ANC attendance. METHODS: The data for this study was extracted from the 2017 Ghana Maternal Health Survey (GMHS). The study population was women aged 15-49 years with a live birth or stillbirth in the 5 years preceding the survey. Data was analysed using STATA/SE version 17, using descriptive statistics and multiple binary logistic regression analysis. RESULTS: It was found that 44.4% of the women obtained eight (8) + ANC visits. A majority of the women (66%) initiated ANC visits in the first trimester of pregnancy. Early ANC visit was significantly associated with age of the respondent, education, wealth index, religion, region and reason for first ANC visit. For instance, women between the ages of 25-29 years (aOR = 1.75, 95% CI: 1.31-2.33) had increased odds of early ANC visit compared to those aged 15-19 years. Women with higher education (aOR = 1.83, 95% CI: 1.27-2.64) were about twice as likely to initiate early ANC visits compared to those with no education. Also, women in the highest wealth index (aOR = 2.43, 95% CI: 1.83-3.23) were two times more likely to initiate early ANC visits compared to those in the lowest wealth index. CONCLUSION: This study has shown that a majority of women in Ghana start their first ANC visit during the first trimester of pregnancy. A considerable proportion of the women failed to meet the WHO's recommendation of having a minimum of eight ANC visits throughout pregnancy. Early ANC visit was determined by socio-demographic factors. Going forward, it should be a priority for stakeholders to ensure that ANC services are accessible to all mothers in a timely manner.

Efficacy of mobile phone intervention to increase male partner antenatal care attendance for HIV testing in Moshi municipal, Tanzania: a randomized controlled trial.

BACKGROUND: HIV partner counselling and testing in antenatal care (ANC) is a crucial strategy to raise the number of males who know their HIV status. However, in many settings like Tanzania, male involvement in antenatal care remains low, and there is a definite need for innovative strategies to increase male partner involvement. This study was designed to evaluate the efficacy of mobile phone intervention increase male partner ANC attendance for HIV testing in Moshi municipal, Tanzania. METHODS: Between April and July 2022, we enrolled pregnant women presenting to a first ANC visit at Majengo and St. Joseph reproductive health facilities without their male partners. Eligible pregnant women were randomly assigned to invitation of their male partners either via phone calls, text messages from clinic staff and verbal invites from pregnant partners (intervention arm) or verbal invites only from the pregnant partners (control arm). Neither healthcare provider nor participant were blinded. The primary outcome was the proportion of male partners who attended ANC with their pregnant partners during a follow-up period of two consecutive visits. The secondary outcome measure was HIV testing among male partners following the invitation. Participants were analyzed as originally assigned (intention to treat). RESULTS: A total of 350 pregnant women presenting to ANC for the first time were enrolled, with 175 women enrolled in each arm. The efficacy of male attendance with their pregnant women following the invitations was 83.4% (147/175) in the intervention arm and 46.3% (81/175) in the control arm. Overall, the results suggest a positive and statistically significant average treatment effect among men who received mobile phone intervention on ANC attendance. For the secondary outcome, the percent of male partners who accepted HIV counselling and testing was 99.3% (146/147) in the intervention arm and 93.8% (76/81) in the control arm. Married men were having higher odds of ANC attendance compared with single men (aOR:6.40(3.26-12.56), Males with multigravida women were having lower odds of ANC attendance compared with primigravida women (aOR:0.17(0.09-0.33). CONCLUSION: The study demonstrates that supplementing verbal invitations with mobile phone calls and text messages from clinic staff can significantly increase male partner ANC attendance and HIV testing. This combined approach is recommended in improving ANC attendance and HIV testing of male partners who do not accompany their pregnant partners to antenatal clinics in the first visits. TRIAL REGISTRATION: PACTR202209769991162.

HIV seroconversion and associated factors among seronegative pregnant women attending ANC in Ethiopia: an institution-based cross-sectional study.

Background: In countries with limited resources, including Ethiopia, HIV is diagnosed using a rapid serological test, which does not detect the infection during the window period. Pregnant women who test negative for HIV on the first test may seroconvert throughout pregnancy. Women who are seroconverted during pregnancy may not have received interventions, as they are considered HIV-negative unless they are retested for HIV at the end of their pregnancy. Due to limited data on HIV seroconversion, this study aimed to measure the extent of HIV seroconversion and to identify associated factors among seronegative pregnant women attending ANC in Ethiopia. Methods: Institution-based cross-sectional study was conducted among HIV-negative pregnant women attending the ANC in Ethiopia between June and July 2020. Socio-demographic, clinical, and behavioral data were collected through face-to-face questionnaires and participants' records review. HIV retesting was performed to determine the current HIV status of pregnant women. The data collected were entered into Epi data version 4.4.1 and were exported and analyzed by SPSS version 25. A p-value < 0.25 in the bivariate analysis was entered into multivariable logistic regression analysis and a p-value of < 0.05 was considered statistically significant. Result: Of the 494 pregnant women who tested negative for HIV on their first ANC test, six (1.2%) tested positive on repeat testing. Upon multivariable logistic regression, pregnant women who have had a reported history of sexually transmitted infections [AOR = 7.98; 95% CI (1.21, 52.82)], participants' partners reported travel history for work frequently [AOR = 6.00; 95% CI (1.09, 32.99)], and sexually abused pregnant women [AOR = 7.82; 95% CI (1.194, 51.24)] were significantly associated with HIV seroconversion. Conclusion: The seroconversion rate in this study indicates that pregnant women who are HIV-negative in early pregnancy are at an ongoing risk of seroconversion throughout their pregnancy. Thus, this study highlights the benefit of a repeat HIV testing strategy in late pregnancy, particularly when the risk of seroconversion or new infection cannot be convincingly excluded. Therefore, repeated testing of HIV-negative pregnant women in late pregnancy provides an opportunity to detect seroconverted pregnant women to enable the timely use of ART to prevent mother-to-child transmission of HIV infection.

Utilizing maternal healthcare services: are female-headed households faring poorly?

BACKGROUND: Utilization of maternal healthcare services has a direct bearing on maternal mortality but is contingent on a wide range of socioeconomic factors, including the sex of the household head. This paper studies the role of the sex of the household head in the utilization of maternal healthcare services in India using data from the National Family Health Survey-V (2019-2021). METHODS: The outcome variable of this study is maternal healthcare service utilization. To that end, we consider three types of maternal healthcare services: antenatal care, skilled birth assistance, and postnatal care to measure the utilization of maternal healthcare service utilization. The explanatory variable is the sex of the household head and we control for specific characteristics at the individual level, household-head level, household level and spouse level. We then incorporate a bivariate logistic regression on the variables of interest. RESULTS: 24.25% of women from male-headed households have complete utilization of maternal healthcare services while this proportion for women from female-headed households stands at 22.39%. The results from the bivariate logistic regression confirm the significant impact that the sex of the household head has on the utilization of maternal healthcare services in India. It is observed that women from female-headed households in India are 19% (AOR, 0.81; 95% CI: 0.63,1.03) less likely to utilize these services than those from male-headed households. Moreover with higher levels of education, there is a 25% (AOR, 1.25; 95% CI: 1.08,1.44) greater likelihood of utilizing maternal healthcare services. Residence in urban areas, improved wealth quintiles and access to healthcare facilities significantly increases the chances of maternal healthcare utilization. The interaction term between the sex of the household head and the wealth quintile the household belongs to, (AOR, 1.39; 95% CI: 1.02, 1.89) shows that the utilization of maternal healthcare services improves when the wealth quintile of the household improves. CONCLUSION: The results throw light on the fact that the added expenditure on maternal healthcare services exacerbates the existing financial burden for the economically vulnerable female-headed households. This necessitates the concentration of research and policy attention to alleviate these households from the sexual and reproductive health distresses. TRIAL REGISTRATION: Not Applicable. JEL CLASSIFICATION: D10, I12, J16.

Preparing solo mothers for childbirth and parenthood - The importance of being with like-minded women.

OBJECTIVES: Denmark and many high-income countries have seen an increase in the number of single women getting pregnant through medical assisted reproduction (MAR). These women are also named solo mothers. According to the Danish Health Authorities, they should, as all other pregnant women, be offered antenatal education. The aim of this study was to explore solo mothers' needs in order to prepare them for childbirth and parenthood. METHODS: This qualitative study was set to investigate solo mothers' experiences and requirements during pregnancy toprepare them for childbirth and parenting. Semi-structured interviews were conducted by telephone or face-to-face. A systematic text condensation and interpretation was used to analyse data. RESULTS: 38 interviews were conducted before and after pregnancy. Twenty solo mothers participated in the study. Three themes emerged from the analysis: 'Confrontation with the normative pregnancy', 'Mirroring and network' and 'Using formal and informal sources to gain information'. CONCLUSION: The conventional antenatal packages offered by the healthcare system did not meet the solo mothers' needs. The women called for content and information tailored to single parents. Solo mothers may benefit from structured antenatal classes in small groups. Being with like-minded women was essential for preparing for childbirth and parenting.

The level of utilization and associated factors of WHO recommended antenatal care visits in South Asian countries.

Background: Antenatal care can play an important role in reducing the death of both mothers and children. This study was designed to find out the determinants of world health organization recommended antenatal care visits in six South Asian countries to achieve the targets for Sustainable Development Goal. Methods: This study used recent demographic and health survey data from six South Asian countries such as Afghanistan (2015), Bangladesh (2017-18), India (2015-16), Maldives (2016-17), Nepal (2016), and Pakistan (2047-18). Descriptive statistics were calculated for the distribution and prevalence of antenatal care visits. Bivariate and multivariable logistic regressions were used to investigate the influencing factors of antenatal care visits. Results: 71,862 women aged 15 to 49 years were included in this study, and 46.64% (95% Confidence Interval = 45.59 - 47.69%) had world health organization recommended antenatal care visits. In the pooled data, urban women (AOR ([Adjusted Odds Ratio]=1.48; 95% CI [Confidence Interval]=1.33-1.66), richest family (AOR=1.48; 95% CI=1.25-1.76), women's higher education (AOR=3.76; 95% CI=3.33-4.25), women's partner/husband's higher education (AOR=1.69; 95% CI=1.50-1.92), 35-49 years (AOR=1.25, 95% CI=1.11-1.42), women's age at first birth >25 years (AOR=1.51, 95% CI=1.36-1.68) and fully media exposure (AOR=2.11; 95% CI=1.74-2.56) were significantly positively associated with WHO recommended antenatal care visits. Whereas, working women (AOR=0.82; 95% CI=0.76-0.88), healthcare decision maker by their husband/others (AOR=0.71, 95% CI=0.60-0.84), ≥7 children (AOR=0.59; 95% CI=0.50-0.69), and ≥7 family members (AOR=0.82; 95% CI=0.73-0.93) had significant negative effect on antenatal care visits. In country specific analysis, overall, media exposure, secondary and above education of women, ≥25 of years age at first birth, and <4 living children were the key factors of antenatal care visits. Conclusions: This study reveals an overall scenario of the WHO-recommended antenatal care visit in South Asian countries, and significant factors related to ANC that we can concentrate onto improve accessibility to healthcare services and promote education and media exposure, especially for rural and less educated women, to increase the prevalence of WHO-recommended antenatal visits in South Asian countries In addition, evidence from this study can be used to assist the policymakers in planning and taking proper steps to increase WHO-recommended antenatal care visits by focusing on the related factors in South Asian countries.

Modeling the spatial patterns of antenatal care utilization in Nigeria with inference based on Pólya-Gamma mixtures.

Despite the vast advantages of making antenatal care visits, the service utilization among pregnant women in Nigeria is suboptimal. A five-year monitoring estimate indicated that about 24% of the women who had live births made no visit. The non-utilization induced excessive zeroes in the outcome of interest. Thus, this study adopted a zero-inflated negative binomial model within a Bayesian framework to identify the spatial pattern and the key factors hindering antenatal care utilization in Nigeria. We overcome the intractability associated with posterior inference by adopting a Pólya-Gamma data-augmentation technique to facilitate inference. The Gibbs sampling algorithm was used to draw samples from the joint posterior distribution. Results revealed that type of place of residence, maternal level of education, access to mass media, household work index, and woman's working status have significant effects on the use of antenatal care services. Findings identified substantial state-level spatial disparity in antenatal care utilization across the country. Cost-effective techniques to achieve an acceptable frequency of utilization include the creation of a community-specific awareness to emphasize the importance and benefits of the appropriate utilization. Special consideration should be given to older pregnant women, women in poor antenatal utilization states, and women residing in poor road network regions.

Predicting risk of preterm birth in singleton pregnancies using machine learning algorithms.

We aimed to develop, train, and validate machine learning models for predicting preterm birth (<37 weeks' gestation) in singleton pregnancies at different gestational intervals. Models were developed based on complete data from 22,603 singleton pregnancies from a prospective population-based cohort study that was conducted in 51 midwifery clinics and hospitals in Wenzhou City of China between 2014 and 2016. We applied Catboost, Random Forest, Stacked Model, Deep Neural Networks (DNN), and Support Vector Machine (SVM) algorithms, as well as logistic regression, to conduct feature selection and predictive modeling. Feature selection was implemented based on permutation-based feature importance lists derived from the machine learning models including all features, using a balanced training data set. To develop prediction models, the top 10%, 25%, and 50% most important predictive features were selected. Prediction models were developed with the training data set with 5-fold cross-validation for internal validation. Model performance was assessed using area under the receiver operating curve (AUC) values. The CatBoost-based prediction model after 26 weeks' gestation performed best with an AUC value of 0.70 (0.67, 0.73), accuracy of 0.81, sensitivity of 0.47, and specificity of 0.83. Number of antenatal care visits before 24 weeks' gestation, aspartate aminotransferase level at registration, symphysis fundal height, maternal weight, abdominal circumference, and blood pressure emerged as strong predictors after 26 completed weeks. The application of machine learning on pregnancy surveillance data is a promising approach to predict preterm birth and we identified several modifiable antenatal predictors.

Socio-economic status and pregnancy complications and their impact on antenatal care services provided at home and Upazila health complex.

The stage of pregnancy is crucial for women of reproductive age and their families. However, in low- and middle-income countries like Bangladesh, antenatal and postnatal care are not widely practiced due to various socio-economic factors, such as low education levels, income, age, pregnancy knowledge, and limited healthcare facilities. The objective of this study was to examine the factors associated with antenatal care in two locations in Bangladesh based on the data collected from the Bangladesh Demographic and Health Survey (BDHS) 2017-2018. We explored different variables as explanatory variables related to ANC service. The results showed that most of the respondents were from rural areas, with 77.02% receiving antenatal care at home. Women with secondary education were more likely to receive care at home than those without education. The Chi-square test indicated a positive correlation between antenatal care at home with several variables, whereas, in the case of Upazila health complexes, only three variables showed a positive association. Logistic regression analysis further showed some specific variables such as geographical division, religion, iron intake during pregnancy, and reporting pregnancy complications had a significant impact on ANC at home. In contrast, covariates such as residence, division, and wealth index were significant for antenatal care at Upazila health complexes. The division was a significant covariate in both cases. Interestingly, we observed that mothers who had been informed about the signs of pregnancy complications were 92% more likely to receive antenatal care at home than those who had not experienced pregnancy complications. Conversely, the results revealed that mothers who were unaware of pregnancy complications were 32% more likely to receive antenatal care at home than those who had been informed about complications. This suggests that when women are educated about pregnancy complications, they are more likely to receive more antenatal care. However, Bangladesh's situation is quite different due to a lack of proper education and knowledge of antenatal care services.

Prevalence and predictors of men's involvement in pregnancy care in Modakeke, Southwest Nigeria.

Introduction: Maternal mortality in developing countries remains a major public health concern and lack of men's support for their spouse during pregnancy contributes to this adverse outcome. This study examined the level and determinants of men's involvement in pregnancy care in Modakeke, Southwest Nigeria. Methods: A community-based cross-sectional, mixed-methods study involving quantitative and qualitative data. A multistage sampling strategy was used to select the study participants. The study involved 414 male respondents interviewed using a structured interviewer-administered questionnaire. The interview was complemented with one focus group discussion facilitated using an unstructured interview guide. Quantitative data were analyzed using descriptive and inferential analytical techniques while qualitative data were explored using thematic content analysis. Results: Findings revealed a 55% level of involvement in pregnancy care among the participants. However, involvement rates were higher among those who were younger, married, from monogamous family, with secondary or tertiary education, low-income earners, and holding positive perception about nontraditional gender roles. Multivariate logistic regression estimates indicated significantly lower odds of involvement among unmarried men than the married but increased odds among those who had secondary or higher education relative to the uneducated, and among those whose partners received antenatal care from multiple providers compared to from health facilities only. Furthermore, significantly reduced odds of involvement were associated with holding nonpositive perceptions towards accompanying spouse to antenatal care clinic and being involved in general pregnancy care as opposed to holding positive perception. Perceived challenges undermining male involvement as highlighted during focus group discussion include time constraints due to job demands, prohibitive sociocultural norms, rebuke and unconducive health facility environment. Conclusion: The level of involvement in pregnancy care is suboptimal among the study participants with considerable sociodemographic, socioeconomic and sociocultural dimensions. Enhancing men's involvement in pregnancy care requires community-based awareness-raising interventions that emphasize crosscutting benefits of male partner's participation in pregnancy-related care and address known sociocultural barriers impeding active involvement.

Who is most vulnerable? Factors associated with presenting to antenatal care without a male partner in Northern Tanzania.

OBJECTIVE: Male engagement in pregnancy care can be beneficial for maternal and child health outcomes. In Tanzania, pregnant women are strongly encouraged to present to their first antenatal care (ANC) appointment with a male partner, where they jointly test for HIV. For some, this presents a barrier to ANC attendance. The objectives of this study were to identify factors associated with presenting to ANC with a male partner using a cross-sectional design and to assess whether women presenting without partners had significantly delayed presentation. METHODS: Pregnant women (n = 1007) attending a first ANC appointment in Moshi, Tanzania were surveyed. Questions captured sociodemographic characteristics and measures of psychosocial constructs. RESULTS: Just over half (54%) of women presented to care with a male partner. Women were more likely to present with a male partner if they were younger than 25 years old, married, Muslim, attending ANC for their first pregnancy, and testing for HIV for the first time. Women presenting to ANC with a male partner were significantly more likely to attend ANC earlier in their pregnancy than those presenting without male partners. CONCLUSION: Policy change allowing women to present to care with other supportive family members could promote earlier presentation to first ANC. Unmarried women may be at a disadvantage in presenting to ANC when policies mandate attendance with a male partner. Male partners of multiparous women should be encouraged to provide pregnancy support even after first pregnancies, and a wholistic emphasis (beyond HIV testing) on first ANC could encourage male engagement beyond the initial appointment.