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Quality of Antenatal Care: Comparison between Secondary and Tertiary Health Facilities in Ibadan, Nigeria  [PDF]
Oluwasomidoyin Olukemi Bello
Open Journal of Obstetrics and Gynecology (OJOG) , 2018, DOI: 10.4236/ojog.2018.86063
Abstract: Background: Patient satisfaction is related to the quality of services received and the extent to which specific needs are met. Satisfied patients are likely to come back for the health services and recommend it to others. Objective: To assess and compare patients’ satisfaction with the quality of prenatal/antenatal care (QPC) services received at a tertiary and secondary health facility in Ibadan, Nigeria. Methods: A comparative cross sectional study used an interviewer administered questionnaire to assess and compare the quality of antenatal care among women who had antenatal care and delivered live baby in two government health facilities—Adeoyo Maternity Hospital (secondary health facility) and University College Hospital (tertiary health facility). A total of 500 women were interviewed within 48 hours post delivery and data obtained was analyzed with SPSS version 20. Results: The mean age was 29.7 (SD = 4.95) years. About half of the respondents had more than four antenatal visits, almost two-thirds (61.4%) were primipara, and 55.6% delivered per vagina. Almost all (98.4%) the women were very satisfied with the QPC received while a little above half (54.0%) received high QPC. Health facility and mode of delivery were found to be significantly associated with the satisfaction of the QPC. Factors predicting high QPC comparing the tertiary and secondary health facility are “availability” (OR = 0.341, 95%CI = 0.173 - 0.672) and “support and respect” (OR = 5.599, 95%CI = 3.621 - 8.659) of health care
Attendance and Utilization of Antenatal Care (ANC) Services: Multi-Center Study in Upcountry Areas of Uganda  [PDF]
Peter Chris Kawungezi, Douglas AkiiBua, Carol Aleni, Michael Chitayi, Anxious Niwaha, Andrew Kazibwe, Elizabeth Sunya, Eliud W. Mumbere, Carol Mutesi, Cathy Tukei, Arabat Kasangaki, Sarah Nakubulwa
Open Journal of Preventive Medicine (OJPM) , 2015, DOI: 10.4236/ojpm.2015.53016
Abstract: Introduction: Globally every year 529,000 maternal deaths occur, 99% of this in developing coun-tries. Uganda has high maternal and neonatal morbidity and mortality ratios, typical of many countries in sub-Saharan Africa. Recent findings reveal maternal mortality ratio of 435:100,000 live births and neonatal mortality rate of 29 deaths per 1000 live births in Uganda; these still remain a challenge. Women in rural areas of Uganda are two times less likely to attend ANC than the urban women. Most women in Uganda have registered late ANC attendance, averagely at 5.5 months of pregnancy and do not complete the required four visits. The inadequate utilization of ANC is greatly contributing to persisting high rates of maternal and neonatal mortality in Uganda. This study was set to identify the factors associated with late booking and inadequate utilization of Antenatal Care services in upcountry areas of Uganda. Method: Cross-sectional study design with mixed methods of interviewer administered questionnaires, focus group discussions and key informant interviews. Data was entered using Epidata and analyzed using Stata into frequency tables using actual tallies and percentages. Ethical approval was sought from SOM-REC MakCHS under approval number “#REC REF 2012-117” before conducting the study. Results: A total of four hundred one were enrolled with the majority being in the age group 20 - 24 years (mean age, 25.87 ± 6.26). Health workers played a great role (72.04%), followed by the media (15.46%) and friends (12.50%) in creating awareness about ANC. A significant number of respondents went to TBAs with reasons such as “near and accessible”, “my husband decided”, and “they are the only people I know”. 37.63% of the respondents considered getting an antenatal Card as an importance of ANC. 71 (19.67%) respondents gave a wrong opinion (late) on booking time with reasons like demands at work, no problems during pregnancy, advised by friends, just to get a card, long distance and others didn’t know. Almost half of the respondents never knew the recommended number of visits. Religion, occupation, level of education, and parity were found to influence place of ANC attendance, number of ANC visits and booking time. Husbands were necessary to provide financial support, accompany their wives ANC clinic, and ensure that they complete the visits. But their response was poor due to: fear of routine investigations and constrained economically. Conclusion: The study findings show the actual rural setting of ANC services attendance and utilization. Much sensitization has to
Antenatal Diagnosis of Isolated Total Arhinia in the Second Trimester of Pregnancy  [PDF]
D. Leroy, E. Slachmuylder, M. Popijn, M. Cassart, A. Massez, N. D'Haene, J. Désir, A. Vandermaelen, C. Daelemans, G. Ceysens, C. Donner
Open Journal of Obstetrics and Gynecology (OJOG) , 2016, DOI: 10.4236/ojog.2016.67055
Abstract: Congenital arhinia is a very rare condition especially when it is isolated. Most of arhinia are identified after birth and only five prenatal cases are described in the literature. Generally, arhinia is associated with other malformations mainly craniofacial anomalies. Genetics aberrations are uncommon. Our case was diagnosed in the second trimester of pregnancy and we found no associated anomaly except for a single umbilical artery. Autopsy confirmed the diagnosis and neuropathology analysis revealed the absence of olfactory bulbs and tracts.
Antenatal Sonographic Diagnosis of A Case of Alobar Holoprosencephaly: A Case Report  [PDF]
Rizwan Ahmad Khan, Manjari Thapa, Shagufta Wahab
International Journal of Clinical Medicine (IJCM) , 2012, DOI: 10.4236/ijcm.2012.35080
Abstract: Holoprosencephaly is a rare congenital brain malformation resulting from failure of diverticulation and cleavage of primitive prosencephalon which occurs at 4 - 8th week of gestation and is usually associated with multiple midline facial anomalies. Herein we report an antenatal case of such patient. Patient was evaluated and because of the magnitude of the problem induction was done which led to a still born baby.
The effect of urine pregnancy testing on timing of accessing antenatal care and abortion services in Western Nigeria  [PDF]
Mustafa Adelaja Lamina
Open Journal of Obstetrics and Gynecology (OJOG) , 2013, DOI: 10.4236/ojog.2013.36089

Objective: Effective confirmation of pregnancy is a basic component of reproductive health services. It is a determinant for accessing antenatal care (ANC) if the pregnancy is wanted and abortion services if the pregnancy is unwanted. This study examined the effect of urine pregnancy testing in the timing of presentation for pregnancy care. Method: A cross-sectional study was conducted among 320 women presenting for antenatal care and 300 women presenting for abortion at private sector clinics in Western Nigeria. Results: The median age at first presentation was 20 weeks for ANC clients and 8 weeks for abortion clients. Obtaining urine pregnancy test of one’s accord was associated with a decrease in the gestational age at presentation of 3.7 weeks and 1.5 weeks for antenatal and abortion clients, respectively, independent of all other factors. Conclusion: Bearing in mind that the clinical benefit and public health impact of early presentation for antenatal and abortion services are unequivocal, strategies aimed at decreasing gestational age at presentation for pregnancy care should be given priority. “Fast-track” urine pregnancy testing services should be promoted in the private and public clinics in Nigeria.

Antenatal anxiety in the first trimester: Risk factors and effects on anxiety and depression in the third trimester and 6-week postpartum  [PDF]
Chui Yi Chan, Antoinette Marie Lee, Siu Keung Lam, Chin Peng Lee, Kwok Yin Leung, Yee Woen Koh, Catherine So Kum Tang
Open Journal of Psychiatry (OJPsych) , 2013, DOI: 10.4236/ojpsych.2013.33030
Abstract: Objective: Anxiety is common among pregnant women. However, research attention in the area of reproductive mental health has mainly focused on postpartum depression in past decades. Given adverse outcomes of antenatal anxiety, there is an urgent need to fill the research gaps. The objectives of the present study were to determine the prevalence of antenatal anxiety symptoms and examine the risk factors and effects of anxiety symptoms in early pregnancy on anxiety and depressive symptoms in later pregnancy and early postpartum period. Methodology: A prospective longitudinal design with quantitative approach was adopted. A consecutive sample of 1470 Chinese pregnant women from hospitals in Hong Kong was invited to participate in the study and was assessed using standardized instruments on 3 time points including first and third trimesters of pregnancy and 6-week postpartum. Results: The results showed that 17.7% of pregnant women manifested anxiety symptoms in the first trimester of pregnancy. Single mothers, younger mothers, mothers who smoked before pregnancy and mothers who received low education level reported significantly higher levels of anxiety symptoms in the first trimester. Unwanted pregnancy, low self esteem, low marital satisfaction and perceived low social support were significant psychosocial risk factors for anxiety symptoms in the first trimester. Anxiety symptoms in the first trimester were independent predictors for anxiety symptoms in the third trimester ( QUOTE β = 0.26, t = 5.74, p < 0.001), however anxiety symptoms in the first trimester no longer significantly predicted anxiety and depressive symptoms in 6 weeks postpartum after adjusting for the
Prevalence of Major Fetal Defects in Fallujah, Iraq  [PDF]
Muntaha Al-Alwani, Ahmed Sameer Alnuaimi
Open Journal of Obstetrics and Gynecology (OJOG) , 2014, DOI: 10.4236/ojog.2014.49081

Background: The prenatal prevalence of congenital anomalies in Iraq is still under debate because of deficiencies in diagnostic capabilities and low reliability of medical registration. Early antenatal diagnosis of fetal defects is important for early counseling, intervention and possible fetal therapy. Objectives: The aim of this study was to estimate prenatal frequency of major congenital anomalies and malformation patterns diagnosed by ultrasound in Fallujah city. Patients and Methods: A cross-sectional study using the recorded data of antenatal diagnosis of major fetal congenital anomalies conducted in Fallujah Hospital—Fetal Medicine Clinic for a period of 20 months (January 2012 to August 2013). During this period one or more obstetrical ultrasound examinations were performed for 2120 pregnant ladies. Results: A total of 178 cases with obvious fetal anomalies were diagnosed. The prenatal prevalence of congenital anomalies was 84 per 1000. The median maternal age at diagnosis was 29 ± 6.3 years. The mean gestational age at diagnosis was 27 weeks ± 5 days. Extremities and urinary system anomalies were the most frequently detected anomalies. Conclusion: The prevalence of structural fetal malformation diagnosed by ultrasound in Fallujah city is obviously higher than internationally reported figures.

Impact of Mobile Telephone on Maternal Health Service Care: A Case of Njoro Division  [PDF]
Tsimbiri Fedha
Open Journal of Preventive Medicine (OJPM) , 2014, DOI: 10.4236/ojpm.2014.45044

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.

Assessment of the Content and Utilization of Antenatal Care Services in a Rural Community in Cameroon: A Cross-Sectional Study  [PDF]
Gregory Edie Halle-Ekane, Thomas Egbe Obinchemti, Jeffrey-Lewis Nnomzo’o Nzang, Ngoe Morike Mokube, Martin Mafany Njie, Theophile Nana Njamen, Boniface T. Nasah
Open Journal of Obstetrics and Gynecology (OJOG) , 2014, DOI: 10.4236/ojog.2014.414119
Abstract: Background: Pregnant women receive antenatal care (ANC) to ensure favorable pregnancy outcomes. Despite the high ANC coverage rate registered nationally in Cameroon; rural women, women with no formal education and those in the most deprived quintile still face difficulties in having access to quality ANC. The impact of the aforementioned factors on ANC use in the Muea Health Area (MHA) is unknown. The objective of this study was to determine the proportion of women attending ANC and the factors influencing ANC attendance in the MHA. Materials and Methods: This was a community based, analytical, cross sectional survey that involved pregnant women and women with children less than two years old who gave an informed consent or assent. Data were collected using a semi structured questionnaire. EPI info Version 7 and Stat Pac for Windows version 12? 1998-2011 (Stat Pac Inc, Bloomington, USA) were used for data analysis. Associations were considered statistically significant for p values less than 0.05. Results: Two hundred and twenty women were interviewed. The mean age was 25 years (SD 5.28). Ninety-nine percent of women had at least one ANC visit meanwhile 84.8% had at least four ANC visits. Only 27.2% of women booked for ANC in the first trimester. Rural (Maumu) residence was associated with inappropriate ANC attendance (attending less than four times) (χ2 = 18.5; p = 0.001). Semi urban women (87%; 95% C.I. = 85.10% - 89.0%) were more likely to attend four or more sessions than rural (Maumu) women (60.7%; 95% C.I. = 44.2% - 77.3%) (p = 0.001). Participant’s educational level was a significant predictor of early booking for ANC (χ2 = 26.8; p = 0.0002). Semi urban wom- en (79.1%; 95% C.I. = 76.0% - 82.2%) were significantly more likely to have a vaginal examination
Current Status of Antenatal Care Utilization in the Context of Data Conflict: The Case of Dembecha District, Northwest Ethiopia  [PDF]
Molla Gedefaw, Bilal Muche, Mekonen Aychiluhem
Open Journal of Epidemiology (OJEpi) , 2014, DOI: 10.4236/ojepi.2014.44027
Abstract: Good antenatal care (ANC) is one of the most important health care aspects known to reduce maternal mortality. In Ethiopia, regional and national data at times do not concur thus data from district to district level decision making are needed. The aim of this study was, therefore, to assess the prevalence and correlates of ANC service utilization. A community based cross-sectional study was conducted among pregnant women. Multistage sampling was used. Pre-tested structured questionnaire was data collection tool. Data were analyzed using SPSS version 16.0 for windows. Logistic regression was used to assess possible association among variables. Odds ratio at 95% confidence interval was used to measure strength, and statistical significance of associations. Prevalence of ANC service utilization was 57%. Of these, more than 80% of them received ANC for ≥4 times. This finding is more similar to the regional report (68%) than that of EDHS (2011) for Amhara Region (34%). Marital status, educational status and income were important predictors for ANC service utilization. The most outstanding finding of this study was that more than 20% and 60% of mothers received antennal care, and information about antenatal care from health extension workers. Antenatal care utilization is still low. Single, divorced, or separated mothers were less likely to utilize ANC while economically better off, and literate mothers were more likely to use ANC services than their counterparts. The finding of this study is in line with the annual reports from the Regional health bureau and disagrees with Ethiopian demographic health survey—EDHS-(2011). Therefore, districts should be encouraged to make decisions based on their own locally generated data than based on EDHS data which could at times be discouraging for districts with better performance. Further strengthening of Health Extension Program is recommended.
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