Objective Antenatal and postnatal cares are crucial for the survival and well-being of both the mother and the child. WHO recommends a minimum of four antenatal care (ANC) visits during a pregnancy. In Ethiopia, only 38% of women in the reproductive age make a minimum of first ANC visits. This value is far below the typical rates of least developed countries. This study aimed to calculate the magnitude and identify associated factors of ANC service utilisation among pregnant women in Ethiopia. Design Cross-sectional study design. Setting Ethiopia. Participants A total of 7913 pregnant women participated in the study. Primary outcome measures Antenatal care service uptake among pregnant women. Result Only 35.5% of the pregnant mothers have used ANC services at least four times and 64.5% of the pregnant mothers have used less than three times during their periods of pregnancy. The study showed that rich women (PR=1.077, 95% CI: 1.029 to 1.127), having access to mass media (PR=1.086, 95% CI: 1.045 to 1.128), having pregnancy complications (PR=1.203, 95% CI: 1.165 to 1.242), secondary education and above (PR=1.112, 95% CI:1.052 to 1.176), husbands’ having secondary education and above (PR=1.085, 95% CI: 1.031 to 1.142) and married (PR=1.187; 95% CI: 1.087 to 1.296), rural women (PR=0.884, 95% CI: 0.846 to 0.924) and women>30 years of age (PR=1.067, 95% CI: 1.024 to 1.111) significantly associated with the ANC service uptake. Conclusion The magnitude of ANC service uptake was low. This low magnitude of ANC service utilisation calls for a need to improve community awareness about maternal health. More importantly, intensive health education is required for pregnant women to have better ANC service uptake and follow-up adherence.

https://bmjopen.bmj.com/content/bmjopen/11/4/e043904.full.pdf

Magnitude of antenatal care service uptake and associated factors among pregnant women: analysis of the 2016 Ethiopia Demographic and Health Survey

Daily, the number of women who die around the world reaches an average of 800; these deaths are a result of obstetric complications in pregnancy and childbirth, and 99% of these deaths occur in low- and middle-income countries. This review probes the use of antenatal care (ANC) and skilled birth delivery (SBD) services in sub-Saharan Africa (SSA) and highlights research gaps using Arksey and O’Malley’s methodological approach. The screening of abstracts and full text was carried out by two independent authors who ensured the eligibility of data extraction from the included articles. An exploration of the data was undertaken with descriptive analyses. In total, 350 potentially eligible articles were screened, and 137 studies were included for data extraction and analysis. From the 137 included studies, the majority were from Ethiopia (n = 40, 29.2%), followed by Nigeria (n = 30, 21.9%). Most of the studies were published between 2019 and 2023 (n = 84, 61%). Significant trends and challenges with ANC and SBD services emerged from the studies. It is revealed that there are wide gaps in the utilization of ANC and SBD services. Policy attention, intervention strategies to improve access, resources, rural–urban disparity, and women’s literacy are recommended to improve the utilization of ANC and SBD services in SSA countries.

Utilization of Antenatal Care and Skilled Birth Delivery Services in Sub-Saharan Africa: A Systematic Scoping Review

The low utilization of antenatal healthcare services among Rohingya refugee women contributes to high maternal and child mortality rates. The objective of this study was to evaluate the prevalence of antenatal healthcare services utilization and the impacts of preconception care and pregnancy intention on accessing these services among Rohingya refugee women in Bangladesh.We analyzed data from 708 women collected through a multistage cross-sectional survey conducted in April 2023. The outcome variable was the uptake of at least one antenatal healthcare services, while the exposure variables were preconception care uptake and unintended pregnancy. We used a multivariate logistic regression model to determine the effects of preconception care and unintended pregnancy on antenatal care utilization, adjusting for potential covariates.Approximately 47 % of women reported not accessing any antenatal healthcare services during their most recent pregnancy. Moreover, around 68 % of women did not receive any preconception care, and nearly one-third of pregnancies were unintended at conception. We observed lower likelihoods of antenatal care utilization among women without preconception care or with unintended pregnancy. The negative effects were even more pronounced when women reported no use of preconception care along with experiencing mistimed (aOR, 0.61, 95 % CI: 0.45-0.77) and unwanted (aOR, 0.43, 95 % CI: 0.34-0.52) pregnancy for their most recent pregnancy.Maternal healthcare service utilization is alarmingly low among Rohingya refugees, with a significant lack of preconception care and a high prevalence of unintended pregnancies. This underscores the critical importance of implementing awareness-building programs to increase uptake of antenatal healthcare services. 

Exploring the impact of preconception care and unintended pregnancy on access to antenatal healthcare services among Rohingya women: Insights from a cross-sectional survey

Abstract Background Primary healthcare (PHC) is a crucial strategy for achieving universal health coverage. Ethiopia is working to improve its primary healthcare system through the Optimization of Health Extension Program (OHEP), which aims to increase accessibility, availability and performance of health professionals and services. Measuring current accessibility of healthcare facilities and workforce availability is essential for the success of the OHEP and achieving universal health coverage in the country. Methods In this study we use an innovative mixed geospatial approach to assess the accessibility and availability of health professionals and services to provide evidence-based recommendations for the implementation of the OHEP. We examined travel times to health facilities, referral times between health posts and health centers, geographical coverage, and the availability and density of health workers relative to the population. Results Our findings show that the accessibility and availability of health services in Somali region of Ethiopia is generally low, with 65% of the population being unable to reach a health center or a health post within 1 h walking and referral times exceeding 4 h walking on average. The density of the health workforce is low across Somali region, with no health center being adequately staffed as per national guidelines. Conclusions Improving accessibility and addressing healthcare worker scarcity are challenges for implementing the primary care roadmap in Ethiopia. Upgrading health posts and centers, providing comprehensive services, and training healthcare workers are crucial. Effective outreach strategies are also needed to bridge the gap and improve accessibility and availability. 

A geospatial analysis of accessibility and availability to implement the primary healthcare roadmap in Ethiopia

Pain is one of the most neglected areas of care in sub-Saharan Africa. Access to adequate pain management is important, especially in marginalised populations, such as pastoralists. Little is known about health professionals’ perceptions of pain-related care for Somali pastoralists. This study seeks to understand health professionals’ perceptions of Somali pastoralists in the context of pain management in Eastern Ethiopia. Within the scope of this qualitative multicentre study, we conducted semi-structured interviews with 17 health professionals (mainly nurses) experienced in treating Somali pastoralists with pain. Data analysis was based on the coding paradigm proposed by Strauss and Corbin within Grounded Theory methodology and resulted in a conceptual model of pastoralist-specific pain management. We gave voice to pastoralists in the study design, for example, through focus group discussions conducted prior to this study. Our study is part of a larger ongoing research project involving health professionals and pastoralist communities. The perspective of pastoralists is explored in a consecutive study. ‘Patient-professional relationship’ was the core category we identified within the conceptual model. This category was closely linked with issues of ‘(mis)trust’ and ‘communication (barriers)’. ‘Patient-related conditions’ (eg, (under)-reporting of pain, care preferences and beliefs) and ‘health professional-related’ conditions’ (eg, insufficient training, (under)exposure to local culture) had an influence on the core category. Contextual factors proved to be relevant as well, such as age and gender. The study highlights the complexity of pain management among marginalised communities, such as pastoralists. Health professionals perceive Somali pastoralists to have distinct illness beliefs and pain concepts influencing their health-seeking behaviour. The study highlights the importance of reaching this patient group with culturally acceptable and comprehensive pain management strategies.

“It is difficult for us to treat their pain”. Health professionals’ perceptions of Somali pastoralists in the context of pain management: a conceptual model

Objective To assess maternal health care service utilisation and associated factors in Somali pastoral communities of eastern Ethiopia. Methods Community-based cross-sectional study complemented by qualitative assessments in Adadle district, Somali region, eastern Ethiopia, among 450 women in six kebeles from August to September 2016. Logistic regression was used to assess factors associated with antenatal care use and skilled delivery care use, controlling for confounders. Results About 27% [95%CI 22.8-31.2%] of women used antenatal care, and 22.6% [95%CI 18.7-26.5%] received skilled delivery service. None of the respondents reported post-natal care. About 43% reported that they had no knowledge of antenatal care, and 46% did not perceive delivery at a health facility as important. Pastoral lifestyle, husband's educational status, women's attitude towards health care service and financial support from the husband were significantly associated with antenatal care utilisation. Health professionals' attitudes, perceptions of institutional delivery, antenatal care utilisation and information about exemptions from maternal health care fees were associated with skilled delivery service utilisation. Conclusion Improving community awareness of antenatal care, employing female health professionals and culturally adapted guidelines could improve skilled delivery utilisation. In a patriarchal society, involving male partners in all maternal health issues is essential to increase use of maternal health services and to decrease maternal mortality.

https://onlinelibrary.wiley.com/doi/epdf/10.1111/tmi.13346

Antenatal care and skilled delivery service utilisation in Somali pastoral communities of Eastern Ethiopia.

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Antenatal care and skilled delivery service utilisation in Somali pastoral communities of Eastern Ethiopia.