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Achieving equitable health and meeting the sustainable development goals commitment of “leaving no woman behind” requires high-quality antenatal care that ensures a positive pregnancy experience. However, limited studies have assessed the quality of antenatal care using the WHO’s quality of care framework, encompassing both experience of care and structural dimensions. This cross-sectional study, conducted from September 1 to October 2, 2020, in the Western Hararghe Zone, Ethiopia, examined the quality of antenatal care among 340 participants selected through multistage stratified sampling. Data were analysed using descriptive statistics and binary logistic regression in SPSS version 27, with significance set at p < 0.05. Results showed that 51.5% [95% CI 46.6–56.8%] of women received quality antenatal care. The domains of effective communication had relatively low quality followed by supportive care then respect, and dignity. The quality of antenatal care was found to be 65.9% and 37.1% in private and public health facilities respectively. Public facilities lacked essential diagnostic equipment, particularly ultrasound. Factors associated with poor antenatal care quality are rural residency, low income, unplanned pregnancies, and public health facilities. Addressing inequities in experience of care coupled with structural attributes is crucial for improving the quality of antenatal care.

Background From 1990 to 2015, the number of maternal deaths globally has dropped by 43%. Despite this, progress in attaining MDG 5 is not remarkable in LMICs. Only 52% of pregnant women in LMICs obtain WHO recommended minimum of four antenatal consultations and the coverage of postnatal care is relatively poor. In recent years, the increased cellphone penetration has brought the potential for mHealth to improve preventive maternal healthcare services. The objective of this review is to assess the effectiveness of mHealth solutions on a range of maternal health outcomes by categorizing the interventions according to the types of mHealth applications. Methods Three international online electronic databases were searched between January 1, 2000 and January 25, 2016 to identify studies exploring the role of mHealth solutions in improving preventive maternal healthcare services. Of 1262 titles screened after duplication, 69 potentially relevant abstracts were obtained. Out of 69 abstracts, 42 abstracts were shortlisted. Full text of 42 articles was reviewed using data extraction sheet. A total of 14 full text studies were included in the final analysis. Results The 14 final studies were categorized in to five mHealth applications defined in the conceptual framework. Based on our analysis, the most reported use of mHealth was for client education and behavior change communication, such as SMS and voice reminders [ n  = 9, 65%]. The categorization provided the understanding that much work have been done on client education and behavior change communication. Most of the studies showed that mHealth interventions have proven to be effective to improve antenatal care and postnatal care services, especially those that are aimed at changing behavior of pregnant women and women in postnatal period. However, little evidence exists on other type of mHealth applications. Conclusion This review suggests that mHealth solutions targeted at pregnant women and women in postnatal period can improve preventive maternal healthcare services. However, there is a need to conduct more controlled-trials and quasi-experimental studies to strengthen the literature in this research area. The review recommends that mHealth researchers, sponsors, and publishers should prioritize the transparent reporting of interventions to allow effective interpretation of extracted data.

Evaluating antenatal care quality involves understanding women’s experiences and their impact on pregnancy outcomes. This study examines how pregnant women in the Netherlands perceive the quality of antenatal care and which factors are related to these perceptions, with a focus on continuity of care. We conducted a cross-sectional study (2019–2020) among 1165 pregnant women (>32 weeks). Perceived quality of care was measured using the Pregnancy and Childbirth Questionnaire. Experienced continuity of care was measured using the Nijmegen Continuity Questionnaire. Regression analyses explored associated factors across both community and hospital care settings. Most women reported moderate-to-high levels of perceived quality. Personal continuity from community midwives, team continuity, and the presence of a coordinating care professional were associated with higher perceived quality. The use of a maternity care plan showed no association. Our findings suggest that involvement of a community midwife enhances perceived quality of antenatal care. Key contributing factors include continuity of care and experiencing a coordinating care professional.

Background Good quality antenatal care (ANC) reduces maternal and neonatal mortality and improves health outcomes, particularly in low-income countries. Quality of ANC is measured by three dimensions: number of visits, timing of initiation of care and inclusion of all recommended components of care. Although some studies report on predictors of the first two indicators, no studies on the third indicator, which measures quality of ANC received, have been conducted in Nepal. Nepal follows the World Health Organization’s recommendations of initiation of ANC within the first four months of pregnancy and at least four ANC visits during the course of an uncomplicated pregnancy. This study aimed to identify factors associated with 1) attendance at four or more ANC visits and 2) receipt of good quality ANC. Methods Data from Nepal Demographic and Health Survey 2011 were analysed for 4,079 mothers. Good quality ANC was defined as that which included all seven recommended components: blood pressure measurement; urine tests for detecting bacteriuria and proteinuria; blood tests for syphilis and anaemia; and provision of iron supplementation, intestinal parasite drugs, tetanus toxoid injections and health education. Results Half the women had four or more ANC visits and 85% had at least one visit. Health education, iron supplementation, blood pressure measurement and tetanus toxoid were the more commonly received components of ANC. Older age, higher parity, and higher levels of education and household economic status of the women were predictors of both attendance at four or more visits and receipt of good quality ANC. Women who did not smoke, had a say in decision-making, whose husbands had higher levels of education and were involved in occupations other than agriculture were more likely to attend four or more visits. Other predictors of women’s receipt of good quality ANC were receiving their ANC from a skilled provider, in a hospital, living in an urban area and being exposed to general media. Conclusions Continued efforts at improving access to quality ANC in Nepal are required. In the short term, less educated women from socioeconomically disadvantaged households require targeting. Long-term improvements require a focus on improving female education.

Background Antenatal care is a special care provided for pregnant women with the aim of preventing, detecting, and treating health problems in both the fetus and mother. Early antenatal care attendance promotes early detection and treatment of complications which result in proper management during delivery and puerperium. However, the majority of pregnant women in Eritrea initiate their ANC booking late. The study aims to assess factors associated with late ANC booking among pregnant mothers attending selected antenatal care services in Zoba Maekel, Eritrea. Method A health facility based cross-sectional study was conducted from February to March 2022 among 439 pregnant women. To select the study participants, a stratified two-stage cluster sampling method was employed and a predesigned and pretested questionnaire was used to collect data regarding factors associated with late antenatal booking. Binary logistic regression analysis was used to assess the association between the outcome variable and the independent variables and a P -value less than 0.05 was considered statistically significant. Result The prevalence of late antenatal care booking was 59% (95% CI 0.54–0.64). Those aged 20–34 years (AOR: 0.26; 95% CI: 0.15–0.44), 34 and above (AOR: 0.21; 95% CI: 0.11–0.33), and those who were unemployed (AOR: 0.45; 95% CI: 0.34–0.59) had decreased odds of late first ANV booking. Having family size of 4 and above (AOR: 2.25; 95% CI: 1.07–4.74), reside in rural areas (AOR = 2.20, 95%, CI: 1.38–3.50), from Muslim religion (AOR = 2.11, 95%, CI: 1.70–2.62), with gravida 2 to 4 (AOR = 2.11, 95%, CI: 1.70–2.62) and gravida 5 and above (AOR = 3.11, 95%, CI: 2.26–4.27) had higher odds of late antenatal care initiation. The odds of late ANC initiation was 1.62 among ANC visitors yet not accompanied by their husband to health center (AOR = 1.62, 95% CI 1.35–1.95). Conclusion This study showed that most pregnant women did not start ANC booking earlier. Further, the study indicated that younger age, rural settlements, family size ≥ 4, from Muslim religion, employees, gravida 4 to 9, and those who did not get husband/family support to ANC follow-up, were highly likely to initiate ANC booking late. Hence, it is crucial to provide health education on the timing of ANC among women of reproductive age. The community's awareness of the importance of receiving early ANC also needs to be promoted.

Background Utilisation of Antenatal care (ANC) in Ethiopia has shown a steady increase in the last two decades, from 27% in 2000 to 74% in 2019. While it is encouraging to see more women attending and receiving ANC, attention to ensuring the quality of the ANC services provided to the visiting women is important. Therefore, this study aimed to assess the provision of recommended ANC services and to identify client related factors associated with the provision of the services. Methods The study was conducted using the 2019 Ethiopian Demographic and Health Survey (EDHS) data. Provision of recommended ANC services was assessed for the EDHS sub-set of 1573 women who had a live birth in the two years preceding the survey and at least one ANC visit. Four components of ANC (i.e. blood pressure measurement, blood and urine test, and counselling on signs of pregnancy complications) were used to measure the provision of recommended ANC services. Bivariable and multivariable analysis was performed to identify client related factors associated with the provision of recommended ANC services. An adjustment was made to account for the complex survey design throughout the analysis (weight, stratification, and clustering). Results About one in two women (49.7%; 95% CI: 44.6–55.0) reported receiving the four components of ANC during their pregnancy. Having a higher educational level (adjusted Odds Ratio [aOR] = 2.84; 95%CI: 1.15–6.97), being in the middle (aOR = 1.87;95% CI: 1.14–3.06), richer (aOR = 2.56; 95% CI: 1.46–4.49), and richest (aOR = 4.21;95% CI: 1.93–9.21) wealth quintiles, and having two to three (aOR = 5.40;95% CI: 2.00-14.60) and four or more (aOR = 13.45; 95% CI: 4.81–37.58) ANC visits were client related factors associated with the provision of recommended ANC services. Conclusion Despite the high ANC1 coverage, only one in two women reported receiving the four recommended services. To produce the desired health outcome from ANC utilisation, expanding the coverage should be accompanied by a strong focus on the contents and quality of care. Moreover, regardless of their educational and economic status, all women should receive all components of care as per the recommendations.

ObjectivesTo identify the determinants of antenatal care (ANC) utilisation in sub-Saharan Africa.DesignSystematic review.Data sourcesDatabases searched were PubMed, OVID, EMBASE, CINAHL and Web of Science.Eligibility criteriaPrimary studies reporting on determinants of ANC utilisation following multivariate analysis, conducted in sub-Saharan Africa and published in English language between 2008 and 2018.Data extraction and synthesisA data extraction form was used to extract the following information: name of first author, year of publication, study location, study design, study subjects, sample size and determinants. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses checklist for reporting a systematic review or meta-analysis protocol was used to guide the screening and eligibility of the studies. The Quality Assessment Tool for Observational Cohort and Cross-Sectional Studies was used to assess the quality of the studies while the Andersen framework was used to report findings.Results74 studies that met the inclusion criteria were fully assessed. Most studies identified socioeconomic status, urban residence, older/increasing age, low parity, being educated and having an educated partner, being employed, being married and Christian religion as predictors of ANC attendance and timeliness. Awareness of danger signs, timing and adequate number of antenatal visits, exposure to mass media and good attitude towards ANC utilisation made attendance and initiation of ANC in first trimester more likely. Having an unplanned pregnancy, previous pregnancy complications, poor autonomy, lack of husband’s support, increased distance to health facility, not having health insurance and high cost of services negatively impacted the overall uptake, timing and frequency of antenatal visits.ConclusionA variety of predisposing, enabling and need factors affect ANC utilisation in sub-Saharan Africa. Intersectoral collaboration to promote female education and empowerment, improve geographical access and strengthened implementation of ANC policies with active community participation are recommended.

Adolescent pregnancy is of public health concern due to high rates of pregnancy-related complications and lower antenatal attendance among adolescent girls and young women. Mobile health (mHealth) interventions have the potential to improve pregnancy health behaviors and thereby birth outcomes. This pilot randomized controlled trial with pre-post design evaluated user acceptability and preliminary efficacy of an mHealth intervention to improve antenatal appointment attendance and its determinants among pregnant adolescent girls and young women in South Africa. The \"Teen MomConnect\" intervention entailed both fixed and 2-way tailored SMS text messages about antenatal appointment keeping and pregnancy health behaviors. The intervention content and functionality were adapted from MomConnect, a national mHealth program that sends fixed SMS text messages to pregnant women in South Africa. Pregnant adolescent girls and young women aged 13-20 years were recruited from health facilities and community networks in Cape Town during May-December 2018. Simple 1:1 randomization was used to allocate participants into the control group that received the standard MomConnect maternal health messages or the experimental group that received the Teen MomConnect intervention. A subset of experimental group participants received an in-person motivational interviewing session. Questionnaires were administered at baseline and after the end of the participants' pregnancies. Appointment attendance data were obtained from clinic records. ANOVA, ANCOVA, and logistic regression models assessed the differences in appointments attended, awareness of HIV status, and the psychosocial determinants of antenatal attendance between the control and experimental groups. Overall, 412 adolescent girls and young women were enrolled, of which 254 (62%) completed the posttest survey (64% control, 59% intervention). Patient record data were obtained for 222 of the 412 (54%; in both control and intervention) participants. A total of 84% (63/75) and 72% (54/75) rated the intervention messages highly regarding their content value and their motivational nature for behavior change, respectively. Participants responded to an average of 20% of the 2-way messages they received. Mean appointment attendance did not differ significantly between the experimental (4.86, SD 1.76) and control (4.79, SD 1.74; P=.79) groups. Appointment attendance was higher among intervention participants who responded to ≥50% of messages (\"high-responders\"; 5.08, SD 1.66) than intervention participants who responded to fewer messages (4.82, SD 1.79) and control participants (4.79, SD 1.74; P=.86). The mean increase in knowledge scores was significantly higher among experimental group high-responders (2.1, SD 3.17) than the control group (0.7, SD 2.73; β=1.50; P=.045). Engagement with the intervention's 2-way messaging was low, which could have impacted the outcomes. However, the intervention content was deemed acceptable. Appointment attendance did not vary significantly between the intervention and control groups. More intensive intervention may be needed to impact appointment adherence. Pan African Clinical Trial Registry (PACTR) PACTR201912734889796; https://pactr.samrc.ac.za/TrialDisplay.aspx?TrialID=9565. RR2-10.2196/43654.

Background Receiving quality antenatal care (ANC) from skilled providers is essential to ensure the critical health circumstances of a pregnant woman and her child . Thus, this study attempted to assess which risk factors are significantly associated with the timing of antenatal care and the number of items of antenatal care content received from skilled providers in recent pregnancies among mothers in Ethiopia. Methods The data was extracted from the Ethiopian Demographic and Health Survey 2016. A total of 6645 mothers were included in the analysis. Multilevel mixed-effects logistic regression analysis and multilevel mixed Negative binomial models were fitted to find the factors associated with the timing and items of the content of ANC services. The 95% Confidence Interval of Odds Ratio/Incidence Rate Ratio, excluding one, was reported as significant. Results About 20% of the mothers initiated ANC within the first trimester, and only 53% received at least four items of antenatal care content. Being rural residents (IRR = 0.82; 95%CI: 0.75–0.90), wanting no more children (IRR = 0.87; 95%CI: 0.79–0.96), and the husband being the sole decision maker of health care (IRR = 0.88; 95%CI: 0.81–0.96), were associated with reduced items of ANC content received. Further, birth order of six or more (IRR = 0.74; 95%CI: 0.56–0.96), rural residence (IRR = 0.0.41; 95%CI: 0.34–0.51), and wanting no more children (IRR = 0.61; 95%CI: 0.48–0.77) were associated with delayed antenatal care utilization. Conclusions Rural residences, the poorest household wealth status, no education level of mothers or partners, unexposed to mass media, unwanted pregnancy, mothers without decision-making power, and considerable distance to the nearest health facility have a significant impact on delaying the timing of ANC visits and reducing the number of items of ANC received in Ethiopia. Mothers should start an antenatal care visit early to ensure that a mother receives all of the necessary components of ANC treatment during her pregnancy. Plain language summary The third Sustainable Development Goals prioritizes maternal mortality reduction, intending to lower the worldwide maternal mortality rate to 70 per 100,000 live births by 2030. Regular antenatal care from a skilled provider reduces maternal mortality by 20%. The overall quality of ANC service is determined collectively by the timing of ANC, and the contents of ANC received. Though there is an increase in ANC visits and the quality of services received, only 74% of women who gave birth in 2019 received antenatal care from a skilled provider, ranging from 85% in the urban to 70% in the rural. Thus, the quality and content of care might remain poor while the coverage of ANC visits is high. Therefore, it is necessary to analyze the levels and risk factors that affect the timing of ANC visits and contents to assess the quality of ANC services. This is the focus of the current study's research. In this study, nationally representative data from the 2016 Ethiopian Demographic and Health Survey was employed. Our study shows that rural residences, the poorest wealth quintile, no education level, unexposed to mass media, unwanted pregnancy, without decision-making power, and being far from the nearest health facility were found to be factors that hinder early initiation of ANC visits and reduce the number of items of ANC received. In conclusion, we ought to initiate an ANC visit early for a frequent antenatal care visit so that a mother will receive the necessary ANC components.

Objectives We examined the utilisation, equity and determinants of full antenatal care (ANC), defined as 4 or more antenatal visits, at least one tetanus toxoid (TT) injection and consumption of iron folic acid (IFA) for a minimum of 100 days, in India. Methods We analysed a sample of 190,898 women from India’s National Family Health Survey 4. Concentration curves and concentration index were used to assess equity in full ANC utilisation. Multivariable logistic regression model was used to examine the factors associated with full ANC utilisation. Results In India, 21% of pregnant women utilised full ANC, ranging from 2.3–65.9% across states. Overall, 51.6% had 4 or more ANC visits, 30.8% consumed IFA for atleast 100 days, and 91.1% had one or more doses of tetanus toxoid. Full ANC utilisation was inequitable across place of residence, caste and maternal education. Registration of pregnancy, utilisation of government’s Integrated Child Development Services (ICDS) and health insurance coverage were associated with higher odds of full ANC utilisation. Lower maternal education, lower wealth quintile(s), lack of father’s participation during antenatal visits, higher birth order, teenage and unintended pregnancy were associated with lower odds of full ANC utilisation. Conclusions Full ANC utilisation in India was inadequate and inequitable. Although half of the women did not receive the minimum recommended ANC visits, the utilisation of TT immunisation was almost universal. The positive association of full ANC with ICDS utilisation and child’s father involvement may be leveraged for increasing the uptake of full ANC. Strategies to address the socio-demographic factors associated with low and inequitable utilisation of full ANC are imperative for strengthening India’s maternal health program.