Tesis: "Antenatal care services"

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McCaw-Binns, Affette Michelle. "Does antenatal care make a difference? An examination of antenatal care in Jamaica and its relationship to pregnancy outcome". Thesis, University of Bristol, 1993. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.335732.

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Candelier, Claire Kathleen. "Studies on antenatal care in the South Wales valleys". Thesis, University of Sheffield, 1994. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.296766.

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Chege, Eunice Nyambura. "Geographic Variations in Antenatal Care Services in Sierra Leone". ScholarWorks, 2018. https://scholarworks.waldenu.edu/dissertations/5062.

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Despite antenatal care presenting opportunities to identify and monitor women at risk, use of recommended antenatal care services remains. Barriers preventing use of antenatal services vary between countries, and limited knowledge exists about the link between geographical settings and antenatal service use. The objective of this cross-sectional quantitative study was to explore geographical variations and investigate how social demographic characteristics affect use of antenatal care for women in Sierra Leone using the Andersen behavioral model. The data used were from the 2016 maternal death surveillance report of the whole counrty (N =706). Logistic regression analysis was used to determine the individual predictor effects on antenatal care, including geographical location, the age of women, marital status, parity, and institution of birth impact. Southern, Northern, and Eastern women had significantly lower odds of attending the recommended antenatal services compared to women in the Western region (OR = .517, p = .019; OR = .497, p = .021; OR = 0.014, p = .041, respectively). The odds of married women attending the recommended antenatal services was 7.3 times more than that of the single women (OR = 7.397). Also, significantly associated with less uptake of recommended antenatal visits was lower education level among women (OR = .517). This study will contribute to positive social change by highlighting inequities in antenatal care use among women, thus allowing for accurate targeting of health promotion programs and ultimately saving lives of mothers and children of Sierra Leone through more inclusive policies.

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Snyman, J. S. "Effectiveness of the basic antenatal care package in primary health care clinics". Thesis, Nelson Mandela Metropolitan University, 2007. http://hdl.handle.net/10948/728.

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Pregnancy challenges the health care system in a unique way in that it involves at least two individuals – the woman and the fetus. The death rates of both pregnant women (maternal mortality) and newborns (perinatal mortality) are often used to indicate the quality of care the health system is providing. In terms of maternal and perinatal outcomes South Africa scores poorly compared to other upper-middle income countries (Penn-Kekana & Blaauw, 2002:14). The high stillbirth rate compared to the neonatal death rate reflects poor quality of antenatal care. Maternal and perinatal mortality is recognised as a problem and as a priority for action in the Millennium Development Goals (Thieren & Beusenberg, 2005:11). The Saving Mothers (Pattinson, 2002: 37-135) and Saving Babies (Pattinson, 2004:4-35) reports describe the causes and avoidable factors of these deaths with recommendations on how to improve care. The quality of care during the antenatal period may impact on the health of the pregnant woman and the outcome of the pregnancy, in particular on the still birth rate. In primary health care services there are many factors which may impact on and influence the quality of antenatal care. For example with the implementation of the comprehensive primary health care services package (Department of Health, 2001a:21-35) changes at clinic level resulted in a large number of primary health care professional nurses having to provide antenatal care, who previously may only have worked with one aspect of the primary health care package such as minor ailments or childcare. Because skills of midwifery or antenatal care, had not been practiced by some of these professional nurses, perhaps since completion of basic training, their level of competence has declined, and they have not been exposed to new developments in the field of midwifery. The practice of primary health care nurses is also influenced by the impact of diseases not specifically related to pregnancy like HIV/AIDS and tuberculosis. The principles of quality antenatal care are known (Chalmers et al. 2001:203) but despite the knowledge about these principles the maternal and perinatal mortality remains high. The Basic Antenatal Care quality improvement package is designed to assist clinical management and decision making in antenatal care. The implementation of the BANC package may influence the quality of antenatal care positively, which in turn may impact on the outcome of pregnancy for the mother and her baby. The aim of this study was to evaluate the effectiveness of the Basic antenatal care (BANC) package to improve the quality of antenatal care at primary health care clinics.

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Mxoli, Winnifred Nonkonzo. "Women's perceptions and experiences of antenatal care rendered by midwives". Thesis, Nelson Mandela Metropolitan University, 2007. http://hdl.handle.net/10948/575.

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The general health status of pregnant women depends largely on the quality of the antenatal services available to them. The provision of good antenatal services ensures early detection and prompt management of any complication or disease that may adversely affect pregnancy outcome. In order to ensure high quality care, antenatal services need to be evaluated at regular intervals, both from provider and client perspective, to ensure their effectiveness in improving the health status of pregnant women. The midwife, as the first contact person for most pregnant women attending antenatal clinics in South Africa, has the potential to play a major role in improving the health status of these women. However, for the midwife to be effective in achieving this, antenatal services need to be effectively utilized by women. One of the factors that affect utilization of any service is client satisfaction with the service being rendered. This study, therefore, explores the perceptions that pregnant women have of the care that they receive from midwives at the selected antenatal clinics. The objectives of the study are to: {u100083} Explore and describe the perceptions and experiences of pregnant women attending antenatal clinic regarding the care they receive from midwives. {u100083} Make recommendations to assist registered midwives in optimizing the accompaniment of women during the antenatal period. A qualitative, descriptive, exploratory and contextual design was used for the study. The sample was chosen from the target population by means of purposive sampling and data was collected through unstructured interviews with the participants. Before data collection, permission was obtained from the Eastern Cape Department of Health and the Nursing Service Manager of the Gateway clinic, in the district hospital where the research was conducted. The Nursing Service Manager was acting as a Medical Superintendent at the time of the study. Written, informed consent was obtained from all participants before conducting interviews. Trustworthiness was ensured by means of Guba’s model throughout the study, and the aspects of truth value, applicability, consistency and neutrality were considered. Tesch’s eight steps of data analysis were used to analyze the data collected, and four main themes were identified namely: • Women perceive midwives as considerate and knowledgeable • Women perceive midwives as lazy and rude • Women experience mixed emotions about the care they receive from midwives • Though their experiences, women identified certain needs in the services and care they received at the clinic. Conclusions were drawn and recommendations for midwifery practice made based on the results of the study, with the aim of improving antenatal services rendered to pregnant women.

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Umunna, Zeluwa Ifeoma. "Exploring the factors that contribute to poor utilization of primary health care services: a study of two primary health care clinics in Nasarawa State, Nigeria". Thesis, University of the Western Cape, 2012. http://hdl.handle.net/11394/4536.

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Magister Public Health - MPH
Introduction: Nigeria operates a three tiered health care delivery system with a large percentage of health care delivery vested at the primary care level. There has been over the years a continued effort by the government to decentralize health care service thereby increasing the range of services provided at the primary care level. Despite all these efforts there is still low utilization of primary health care services. This study therefore seeks to explore the factors that may be responsible for poor utilization of primary health service in Nasarawa State, Nigeria using two primary health clinics in Lafia local government area as case studies. Methodology: The study was carried out using the qualitative research methodology primarily using two data collection methods, the focus group discussions and individual interviews. A total of sixty participants were sampled, these consisted of ten members of staff, twenty non facility users and thirty facility users. Thirty individual interviews were conducted and four focus group discussions held with staff and facility users at the two clinics. Facility users were randomly selected as they attended the clinic on the data collection days and were invited to participate in the study. Every second patient attending the clinic was selected for the focus group discussion and every third person for the interviews. The staff participants were randomly selected based on their availability while non-facility users were selected using snowballing. Data was analyzed using thematic analysis method. Findings: Two major themes emerged following data analysis; these were perception and experiences of facility users and barriers to utilization of health services. Users had a good perception of the services they received and are reasonably satisfied but certain deficiencies in the health care systems compromised the quality of service. Several factors were however hindering the utilization of these services and these include mainly institutional factors such as lack of infrastructure, equipment and staffing constraints; household factors such as cost of service and responsibility of decision making and other factors such as stigmatization and beliefs. Conclusion: Facility users of these clinics seem to have an overall good impression of services at the clinics; however there are certain fundamental deficiencies that need to be urgently addressed to improve the care provided at these clinics as these constitute barriers to utilization. These deficiencies such as the absence of electricity and water, lack of basic work equipment and inappropriate staff composition need to be addressed by the local government health department to ensure utilization and improved quality of service.

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Bayouh, Fikirte Girma. "Developing antenatal maternal mental health services: Identifying depression in pregnant women attending antenatal care in Sodo district health centres, Ethiopia". Master's thesis, Faculty of Health Sciences, 2020. http://hdl.handle.net/11427/32589.

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Background Major Depressive Disorder is a leading cause of disease burden for women of childbearing age. The prevalence of perinatal depression is significantly higher in women from low and middle income countries than from high income countries. Antenatal depression is associated with low birth weight and preterm delivery. There is also evidence that depression during pregnancy can alter the development of a woman's fetus and her child, with an increased risk for child emotional and behavioral problems. Detection of perinatal depression in primary health care (PHC) is very low. This research gathered evidence on the current practice of detection of pregnant women with moderate-severe depression in the Sodo district and explored potential solutions to the identified challenges. Methods A qualitative study was conducted in four health centres and a primary hospital, located in the Sodo district, Ethiopia. In-depth interviews were carried out with pregnant women diagnosed to have depression. Focus group discussions (FGDs) were conducted with antenatal care (ANC) PHC workers. A framework approach to qualitative data analysis was used. OpenCode computer software was used for data handling during the analysis. Results Nine pregnant women were interviewed in-depth and twelve ANC PHC workers participated in two FGDs. Identified themes were categorized under client, provider and system level barriers, and illness related influences. Women's reluctance to disclose symptoms and seek help and not thinking what they had was an illness and/or not thinking they would get help from ANC clinic were client-side barriers to identifying depression. ANC PHC workers not asking about depressive symptoms, their reluctance to disclose a diagnosis of depression to the affected women and not thinking women with mental health problems are in their clinics were the main provider level barriers. The setting not being conducive for depression assessment, inadequate mental health training and ANC assessment format not having a place for recording mental health assessment were system level barriers raised. Difficulty in differentiating clinical depression from normal emotional reaction emerged as the main illness related influence. ANC PHC workers proposed community awareness-raising, improving communication between women and PHC workers and making mental health assessment part of the routine ANC service, among others, as possible solutions to improve detection of antenatal depression in ANC clinics. Conclusion Multiple client, provider and system level barriers to detection of depression in pregnant women in ANC clinics were identified in the current study. The identified barriers call for interventions at different levels; awareness raising at a community level, training on communicating about emotional concerns and mental health care at a provider level and enabling the health care system to support integration of mental health care into maternal health services at a higher level. Follow-up studies are required to better understand the experiences of women and providers, to quantify the magnitude of the problem and to develop and evaluate contextually appropriate interventions to improve detection of depression in pregnant women.

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8

McKnight, Agnes. "An analysis of antenatal care in Belfast with special emphasis on health education and consumer opinion". Thesis, Queen's University Belfast, 1986. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.328059.

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Hutton, Guy Peter Coats. "Can the costs of the World Health Organisation antenatal care programme be predicted in developing countries?" Thesis, London School of Hygiene and Tropical Medicine (University of London), 2001. http://researchonline.lshtm.ac.uk/4646512/.

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The aims of this thesis are to identify and test alternative methods for analysing and predicting health care costs, to construct a framework for guiding analysts in making better cost predictions, and to identify future areas of research in this area. The thesis uses costs collected from a multi-country trial measuring the cost-effectiveness of an evidence-based programme of antenatal care. Detailed costing studies of maternity services (antenatal care, childbirth and postpartum care) were done in two trial countries (Cuba and Thailand), and also a nontrial country, South Africa. Costs are broken down and reviewed by cost components: prices, resource use, and health service use. The review initially considers the application of economic theory to public health care institutions, to identify factors likely to cause cost variation between setting. Then the review seeks empirical evidence proving or disproving the existence of these factors from the health care literature, as well as a review of the methods for analysing health care costs. The empirical analysis first compares health service use, unit costs and cost per pregnancy between settings (between: women with different case-mix, health facilities, trial arms and 'study countries) and examines the causes of variation, before testing alternative cost prediction methods. Variations in unit cost are found to be due to several factors, including different levels of resource productivity, occupancy levels, staffing patterns, prices and exchange rates (between country), input mix and health facility size. Also, uncertainty and measurement error are considered likely to cause some variation in unit costs. Variations in health service use are due to case-mix, clinical practice, and accessibility differences. Again, not all variation is explained. Finally, a range of different cost predictions methods are tested, and their results compared with observed costs in each country. The most accurate cost prediction method is to build costs based on expected changes in resource use, health service use and morbidity rates (called the incremental cost impact approach). The direct and adjusted cross-country transfer methods (transfering costs between countries), although accurate on occasions, are less reliable. Cost predictions using predictors from a regression analysis are highly unreliable for cross-country predictions. Methodological issues and policy implications in relation to cost prediction and generalisability are discussed, including the choice of cost-prediction approach, the valuation methods (opportunity cost and currency conversion methods for cross-country predictions), the measures used for comparing the performance of cost prediction methods, and the limitations· of cost analyses to understand costs. It was concluded that caution is needed in predicting costs both within study countries due to cost variability, and in lower-resourced settings where u,nit costs and health service use are lower. Further cost analyses and testing of cost prediction methods are needed in other areas of health care to compare with the results from this thesis, and build a fuller picture of cost behaviour as well as strengths and weaknesses of alternative cost prediction methods.

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10

Nguyen, Thu Ha Chanya Sethaput. "Factors influencing utilization of maternal health care services in northern Vietnam /". Abstract, 2005. http://mulinet3.li.mahidol.ac.th/thesis/2548/cd381/4738660.pdf.

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11

Ye, Yang, Yoshitoku Yoshida, Harun-Or-Rashid Md y Junichi Junichi Sakamoto. "Factors Affecting the Utilization of Antenatal Care Services among Women in Kham District, Xiengkhouang Province, Lao PDR". Nagoya University School of Medicine, 2010. http://hdl.handle.net/2237/12906.

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12

Sondakh, Nora Louisa Chanya Sethaput. "Quality of antenatal care service in Indonesia : do mother's characteristics play an important role? /". Abstract, 2003. http://mulinet3.li.mahidol.ac.th/thesis/2546/cd357/4538004.pdf.

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13

Karanika, Vassiliki Lekea. "Greek national perinatal survey : the associations between socioeconomic characteristics of the family, maternal obstetric history, antenatal care features and pregnancy outcome". Thesis, University of Bristol, 1991. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.385731.

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Co, Rose Noemi T. Kusol Soonthorndhada. "An evaluation of the effects of antenatal care utilization on birth weight in the Philippines /". Abstract, 2003. http://mulinet3.li.mahidol.ac.th/thesis/2546/cd357/4538006.pdf.

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Steyn, Petrus Schonken. "Development and validation of a scale to measure patient satisfaction with antenatal care". Thesis, Stellenbosch : University of Stellenbosch, 1999. http://hdl.handle.net/10019.1/95694.

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Thesis (MA)--Stellenbosch University, 1999.
ENGLISH ABSTRACT: There is no standardised instrument available in South Africa to measure patient satisfaction with antenatal care. The measurement of patient satisfaction is especially important after the implementation of a free antenatal care service in the South African health system. The purpose of this study was to develop and validate an appropriate scale to measure patient satisfaction. Several methods to measure patient satisfaction are described in the literature. A questionnaire was developed for the Tygerberg Hospital patients. This questionnaire was tested in 200 antenatal patients through a structured interview. The importance of cross-cultural research is emphasised in the validation of the measuring instrument. Factor analysis was used to validate the instrument. This showed that a single factor accounted for most of the total variance. All the items had to do with the process of antenatal care. The findings of this survey showed the following: • One cannot use overseas measuring instruments without adjusting for cross-cultural differences. • The patient satisfaction score is negatively skewed with a high mean. • Social desirability response sets may play an important role in these questionnaires. • There is a statistically significant difference in patient satisfaction with antenatal care between the different antenatal clinics, even after controlling for socio-demographic differences. • That the satisfaction score is a reflection of the service rendered to the patient and not of the socio-demographic differences. This research identified the difficulties of developing a standardised instrument to measure patient satisfaction with antenatal care and opens the way for future research into patient satisfaction with medical services.
AFRIKAANSE OPSOMMING: Daar is geen gestandaardiseerde meetinstrument om pasiente se tevredenheid met voorgeboortesorg in Suid Afrika te bepaal nie. Die noodsaaklikheid van die bepaling van tevredenheid met voorgeboortesorg het nou belangriker geword nadat 'n stelsel van gratis voorgeboortesorg in Suid-Afrika gei"mplementeer is. Die doel van hierdie navorsing was om 'n skaal te ontwikkel om pasiente se tevredenheid met voorgeboortesorg te bepaal en om die geldigheid van hierdie meetinstrument plaaslik te toets. In die literatuur is daar verskeie metodes om pasiente se tevredenheid te bepaal. 'n Vraelys is ontwikkel vir Tygerberg Hospitaal se voorgeboorte pasiente. Hierdie vraelys is getoets by 200 pasiente in die voorgeboorte klinieke in Tygerberg Hospitaal deur middel van 'n gestruktureerde onderhoud. In die geldigheidsbepaling van die meetinstrument 1s die belangrikheid van kruiskulturele navorsing beklemtoon. Faktoranalise is gebruik vir die bepaling van geldigheid. Met faktoranalise is aangetoon dat een onderliggende faktor, naamlik die voorgeboortesorgsisteem, pasiente se tevredenheid verklaar. Die bevindings in hierdie ondersoek het die volgende getoon: • Dat aile meetinstrumente nie summier transkultureel toegepas kan word nie . • Dat die tevredenheidsmeting van voorgeboortesorg 'n negatiewe skewe verspreiding het, met 'n hoe gemiddelde telling. • Sosiaal-aanvaarbare antwoorde speel waarskynlik 'n groat rol in hierdie vraelyste. • Dat daar 'n statistiese betekenisvolle verskil is in die tevredenheidsgraad van pasiente met voorgeboortesorg tussen sommige klinieke; selfs nadat gekontroleer is vir sosiodemografiese verskille tussen pasiente. • Dat die tevredenheidsmeting 'n weerspieeling is van die diens gelewer aan die pasient, en nie net 'n weerspieeling is van die pasient se sosio-demografiese verskille nie. Hierdie navorsmg identifiseer die probleme met die opstel van 'n gestandaardiseerde meetinstrument vir die bepaling van pasente se tevredenheid met voorgeboortesorg en baan die weg vir verdere navorsing oor pasiente se tevredenheid met mediese dienste.

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Stenson, Kristina. "Men's Violence against Women – a Challenge in Antenatal Care". Doctoral thesis, Uppsala : Acta Universitatis Upsaliensis : Univ.-bibl. [distributör], 2004. http://urn.kb.se/resolve?urn=urn:nbn:se:uu:diva-4140.

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17

Mokhondo, Kgabiso Rachel. "The effect of involving the private practioners on the quality of antenatal care of the indigent population of Tembisa". Diss., University of Pretoria, 2011. http://hdl.handle.net/2263/25747.

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INTRODUCTION. The perinatal mortality rate is of concern worldwide. In South Africa at the time of the study, 2000, it was estimated to be of the order of 40/1000 live births. However in the setting in which this study took place, namely Tembisa, (Ekhuruleni, Gauteng, South Africa) it was said to be 50/1000 live births. One of the patient- related avoidable factors that has been found to be associated with perinatal and to a lesser extent maternal mortality, is either no, or late initiation of antenatal care. It has been found in an area which, is in many respects similar to Tembisa that 50% of women go the private general practitioner (PGP) for confirmation of pregnancy but, due of lack of funds, do not continue care with the private practitioner but, initiate care in the public sector and in a proportion of these women, this is at an advanced gestational age, making it difficult to prevent or intervene if there are problems in the pregnancy. As (PGP’s) are well placed in the district to render antenatal care, it was decided to perform a study looking at the effect of involving them in the antenatal care of women who presented to them for confirmation of pregnancy. METHODS Sixteen general practitioners agreed to be part of the study. The women who confirmed their pregnancy and who were going to deliver in Tembisa hospital were included in the study after giving written informed consent. They comprised the intervention group, the first antenatal visit was performed, the findings were recorded on the antenatal card which is used in the public sector and which was introduced to the private practitioner at 2 workshops held by the Department of Obstetrics and Gynaecology, University of Pretoria prior to the study. The woman was then to attend antenatal care with the private practitioner until delivery. The private general practitioners waived the costs normally associated with this care for the period of the study. The control group consisted of the women who confirmed their pregnancies in the public health care sector known as the public service health care workers group (PSHCWG). Data collection took place in the postnatal ward of Tembisa hospital over the period of 3 months. By means of systematic sampling, 100 cards from the PGPG and 100 cards from the PSHCWG were obtained. The 2 groups were compared with respect to gestational age at initiation of care and a modified version of the Quality Check for Antenatal Records Score (MQCARS), an audit score which, when applied to the antenatal card, gives a measure of the effectiveness of record keeping, and whether problems in the antenatal period are detected and appropriately managed. RESULTS. There was a statistically significant difference between the two groups in terms of gestational age at initiation of care [PGPG mean gestational age -19.96 (5.86), PSHCW 25.96(5.98,) p<0.0001]. The majority of women in the PGPG initiated care in the 2nd trimester (79%) while the majority of the women in the PSHCWG (53%) confirmed their pregnancies in the third trimester. Six per cent of PGPG confirmed their pregnancies in the first trimester compared to the PSHCWG (3%). The two groups differ significantly with respect to the total MQCARS with the PGPG group performing better [(8.16 (1.55) vs. 16.34(2.58), p<0.0001]. The associated sub- scores are statistically different [History score 5.99 (0.10) vs.7 (0.96), Examination score 9.59(1.29) vs.8.03 (1.85) Interpretation Score 2.55(0.50) vs.2.80 (0.49)]. CONCLUSION Despite the limitations of the study it is felt that if private general practitioners in Tembisa are involved in the antenatal care of those women who confirm their pregnancies with them, there is a reduction in the gestational age at initiation of care. There is a small difference between the two groups in record keeping, detection and management of problems.
Dissertation (MCur)--University of Pretoria, 2011.
Nursing Science
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Yan, Nicole. "Integrating point-of-care testing (POCT) for HIV, syphilis, malaria and anaemia into antenatal care services at dispensaries in western Kenya". Thesis, Liverpool School of Tropical Medicine, 2018. http://archive.lstmed.ac.uk/9471/.

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HIV, syphilis, malaria, and anaemia are major causes of adverse pregnancy outcomes in sub-Saharan Africa (SSA). Despite global and national policies advocating for screening of these conditions, only HIV testing has achieved good coverage, precluding early detection and appropriate management in pregnancy. Rapid pointof-care tests (POCTs) provide an opportunity to integrate diagnosis and provide timely treatment of these conditions in rural antenatal care (ANC) settings. After an introductory chapter, a review of the literature on these four conditions in pregnancy is presented with a focus on SSA. The thesis then shifts attention to Kenya, a country that embodies many of the disease challenges and health system characteristics of the region. Kenyan ANC policy recommends testing for HIV, syphilis and anaemia and preventive strategies for malaria. The following chapters are comprised of three linked studies conducted in western Kenya, that use different methods to progressively investigate the implementation success of integrated point-of-care testing (POCT) for HIV, syphilis, malaria and anaemia at seven peripheral dispensaries. Baseline data confirmed that testing requirements for syphilis, malaria and anaemia are not currently met at dispensary level. We implemented an intervention where test kits were supplied and training plus supervision were provided to enable healthcare workers to conduct integrated POCT for pregnant women. Adoption and fidelity were measured quantitatively using exit interviews, antenatal registers and proficiency scores (Study 1: Integrating point-of-care testing (POCT) for HIV, syphilis, malaria and anaemia in antenatal care at dispensary level in western Kenya: an implementation study) while acceptability, appropriateness and feasibility were assessed qualitatively (Study 2: Exploring healthcare workers and pregnant women’s perspectives on appropriateness, acceptability and feasibility of integrating point-of care testing: A qualitative study). Our findings show that the innovation was highly adopted, meaning almost all pregnant women received the essential tests. This was supported by the qualitative findings where healthcare workers and pregnant women found the innovation acceptable and appropriate. However, fidelity to clinical management guidelines can still be improved. Our qualitative findings provide some explanation for these gaps. One common sentiment among interviews with healthcare workers was that workload was perceived to be a barrier to providing quality care. We explored this further with discrete-event simulation modelling (Study 3: Investigating the operational impact of integrating HIV, syphilis, malaria and anaemia point-of-care testing in antenatal care clinics in western Kenya: a discrete event simulation model) and found the healthcare workers were actually under-utilized. This suggests that nurses should, in theory, have sufficient time to deliver essential ANC services. While integrating POCT addresses one gap, additional interventions to support and supervise healthcare workers are needed to ensure appropriate and high quality of care. An integrated approach to health systems strengthening and more investment in implementation and translation research using multi-methods are needed.

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Tibuludji, Yvonne Paula. "The assessment of quality of antenatal care services in Timor Tengah Selatan district, Nusa Tenggara Timur province, Indonesia /". [St. Lucia, Qld.], 2004. http://www.library.uq.edu.au/pdfserve.php?image=thesisabs/absthe19075.pdf.

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Ngwanya, Thandi Rose-mary y Marie Williams. "Facilitated empowerment of midwives to enhance utilization of antenatal care services by pregnant women in the Mnquma sub-district in the Eastern Cape province". Thesis, Nelson Mandela Metropolitan University, 2016. http://hdl.handle.net/10948/12517.

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Background: Antenatal care is essential care that assists in maintaining a state of good health for the woman and her unborn baby. Globally the use of antenatal care services remains a challenge and this tendency is closely associated with maternal and neonatal mortalities and morbidities. South Africa has adopted a free service policy for pregnant women, their infants and for children up to the age of six. Despite this policy, the problem of limited utilisation of antenatal care services by pregnant women is still observed in this country and is associated with increased maternal and neonatal mortalities and morbidities.The purpose of the current proposed study was to explore and describe the reasons for limited utilisation of antenatal care services in the Mnquma sub-district, and to develop guidelines to assist the midwives to encourage the use of antenatal care services. Objectives:To explore and describe the reasons for the limited utilisation of antenatal care services by pregnant women at Mnquma sub-district.To explore and describe the knowledge of antenatal care services by the pregnant women.To develop guidelines to facilitate empowerment of midwives to enhance utilisation of antenatal care services by pregnant women in the Mnquma sub-district in Eastern Cape Province. The study was conducted in Mnquma sub-district during the months of July to January in 2016 using a qualitative, exploratory, descriptive and contextual research design. The research population were post-delivery women and the purposive sampling was used to identify women who met the stated criteria. One-on-one audio-taped semi-structured interviews were conducted and field notes were kept to justify some of the themes identified. Thirteen interviews were conducted and transcribed verbatim. Collected data was analysed using Tesch’s data analysis method. Trustworthiness was maintained through the standards of truth value, credibility, transferability, dependability and conformability. The ethical considerations of beneficence, justice, autonomy, non-maleficence and veracity were maintained. From the findings it emerged that the participants raised various concerns with regard to barriers influencing limited utilization of antenatal care services. The participants had limited knowledge of antenatal care services. Furthermore, participants recommended some solutions to enhance utilization of antenatal care services. Recommendations were made with regard to clinical practice, nursing education and nursing research. Guidelines were formulated to assist midwives to enhance the utilization of antenatal care services by pregnant women in the Mnquma sub-district in the Eastern Cape.

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Tsawe, Mluleki. "Inequalities in the use of maternal and reproductive health services in Sierra Leone". University of the Western Cape, 2019. http://hdl.handle.net/11394/6660.

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Philosophiae Doctor - PhD
This thesis extends the literature on the trends and magnitude of health inequalities in the area of maternal and reproductive health services in Sierra Leone, and particular across sub-Saharan Africa. It attempted to provide a good understanding of, not only the determinants of maternal and reproductive healthcare use, but also factors that enable health inequalities to exist in Sierra Leone. This is an appropriate topic in population health studies as it aims to address important questions on the research agenda in the context of sub-Saharan Africa, particularly in a country with poor health outcomes such as Sierra Leone. A proper understanding of not only the coverage rates of population health outcomes but also the extent of health inequalities as well as the factors that contribute to these inequalities is crucial for any government. The thesis applied various techniques in the analysis of DHS data (from 2008 and 2013 rounds) in an attempt to answer the research questions.

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Zangmo, Dechen Aphichat Chamratrithirong. "The factors affecting the practice of delivery among the pregnant women who received antenatal care during their pregnancy in Bhutan /". Abstract, 2006. http://mulinet3.li.mahidol.ac.th/thesis/2549/cd392/4838754.pdf.

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Erlindawati, Jiraporn Chompikul. "Factors related to the utilization of antenatal care services among pregnant women at health centers in Aceh Besar district, Nanggroe Aceh Darussalam province, Indonesia /". Abstract, 2008. http://mulinet3.li.mahidol.ac.th/thesis/2551/cd414/5038113.pdf.

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Docherty, Angie. "Does the socioeconomic background of pregnant women make a difference to their perceptions of antenatal care? : a qualitative case study". Thesis, University of Stirling, 2010. http://hdl.handle.net/1893/2313.

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Socioeconomically deprived women are at greater risk of adverse pregnancy outcomes. To counteract this, attention tends to focus around access (equality) of services. Yet access may not equate with the meaningfulness (equity) of services for women from different socioeconomic backgrounds. Without understanding equity we are not in a position to plan appropriate and equitable care. This study aimed to determine pregnant women's perceptions of the current antenatal provision and to determine if women from the extremes of socioeconomic background perceived their antenatal care differently. Longitudinal interviews were undertaken with multiple, comparative antenatal case studies between January 2007 and April 2009. Cases were primigravida women from ‘least deprived’ (n=9) and ‘most deprived’ (n=12) geographical areas as identified by the Scottish Index of Multiple Deprivation (SIMD 2006). The data were analysed using case study replication analysis. Analysis of categorical data from the sample groups indicated they were less diverse than might have been expected in terms of age and education. However in the key variables of housing tenure, potential income and socioeconomic status based on area of residence, the groups were indicative of the SIMD target populations. The preliminary analysis showed that the sample groups considered the initial General Practitioner contact to be less than adequate and the subsequent utility of antenatal education to be based on self perceived relevance. The substantive analysis showed little difference in access to antenatal services between the ‘least’ and ‘most’ deprived groups but perception of care differed. A key difference concerned the level of ‘engagement’ (defined as personalisation and active involvement in care, power and relationships and health literacy). Using these concepts, engagement was present in most of the ‘least deprived’ group and almost none of the ‘most deprived’ group. In comparison with women from affluent areas, more deprived women described less evidence of: personal connection to their own care; shared decision making; and perceived value in relation to the written educational aspects of antenatal care. In terms of the preliminary analysis, the results suggest that utility of educational material may need to be reviewed to ensure it is relevant to specific needs. Without this relevance, key information may be missed. The substantive analysis suggests that for women from socioeconomically deprived areas, access may be a less useful indicator than engagement when assessing quality of antenatal services. The lack of engagement perceived by those who are most deprived suggests that equity of service has yet to be attained for those who are most in need. Future research needs to be directed to the potential reasons that may undermine equity and engagement in women from lower socioeconomic areas.

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Gebrehiwet, Tesfay Gebregzabher. "No woman should die while giving life : Does the Health Extension Program improveaccess to maternal health services in Tigray, Ethiopia?" Doctoral thesis, Umeå universitet, Epidemiologi och global hälsa, 2015. http://urn.kb.se/resolve?urn=urn:nbn:se:umu:diva-101210.

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Resumen

Introduction: Ensuring access to universal primary health care is essential to secure a safe and pleasant motherhood and to provide compassionate care for mothers and newborns.However, inequalities in the access to maternal health services still remain a prominent problem in many countries. As part of reducing inequalities, Ethiopia launched the Health Extension Program (HEP) in 2003. The HEP is a community based program designed with a defined package of essential promotive, preventive and basic curative services targeting households, particularly mothers and children. Despite the construction of over 600 health posts and deploying more than 1200 Health Extension Workers (HEWs), preliminary data suggests a low utilization of maternal health care services. This thesis explores the HEP contribution in improving women’s access to maternal health care, and the reasons for the low use of maternal health care services from the perspectives of the involved actors in the Tigray region in Ethiopia. The five dimensions of access were used as a framework to explore the access to maternal health care utilization in this setting. Methods: A total of four districts were included in the study. Both quantitative and qualitative methods were applied. In the first sub-study, we assessed the HEP and its association with change in the utilization of antenatal, delivery and postnatal care services. Retrospective longitudinal data for 10 years was extracted from three selected districts and checked for accuracy. Segmented linear regression technique was used to control the secular trends adjusted for correlation of the data. For the second sub-study, we conducted a cross sectional survey with 1115 women (aged 15-49 years who had given birth within five years prior to the survey period) to determine the prevalence of antenatal care and institutional delivery utilization and explore their determinant factors of low utilization. For the third sub-study, we conducted six focus group discussions (FGDs) with a total of 51 women to explore women’s experiences of childbirth and maternal care. An interview with eight HEWs and four midwives were carried out to capture health workers’ perspective on access to maternal health care services in the fourth sub-study. Grounded theory for the former, and thematic analysis for the latter were used for the analysis. Main findings: The finding of the first sub-study showed a statistically significant upward trend for delivery care (DC) and postnatal care (PNC) in all facilities during the HEP late implementation period (July 2008-June 2012). In addition, a substantial trend of antenatal care (ANC) service use was observed at health centres after the intervention. In the second sub-study, the determinant predictors for ANC utilization were: proximity to health facilities, to be married, ≥5 years of education and having non-farming husbands. The last three factors were also significantly associated with institutional delivery, but also lower parity, previous history of obstructed/prolonged labour and ANC counselling. Findings from the qualitative studies pointed out that elderly women influenced women’s decision making about where to give birth. Women were mostly positive about giving birth at health facilities, but were concerned about the poor quality of care, inaccessibility and unavailability of transport. From the health workers’ perspective: specialized performance of hospital services, community assistance during referral and an increased awareness among women regarding the benefits of giving birth at a health facility were perceived as facilitators for institutional deliveries. Poor perceived competence of HEWs, poor conditions of health care facilities and inaccessibility of transportation, among others, were perceived as barriers for giving birth at health facilities. Conclusion: Overall, this research revealed a considerable contribution of the HEP in improving the access and coverage of maternal health services (ANC, DC and PNC). However, cultural traditions, scattered localities, mountainous roads without adequate transportation and low quality of care are still the major obstacles to accessing the services. Mechanisms need to be designed to enable health facility access of safe delivery for women in hard to reach areas, improving the proficiency of health workers and introducing a women centered approach that enhances acceptability of the services.
ሽፋን መሰረታዊ ክንክን ጥዕና ምዕባይ ድሕንነት ኣዴታትን ህፃናትን ንኽረጋገፅ ዝለዓለ ተራ ከምዘለዎ ይፍለጥ፡፡ ይኹንደኣምበር ግልጋሎት ጥዕና ኣዴታት ብማዕረ ኣብ ምብፃሕን ብምዕሩይ ኣገባብ ኣብ ምሃብን ብዙሓት ሃገራት እናተፀገማ እየን፡፡ ነዚ ዘይምዕሩይን ማዕረ ዘይኾነን ኣዋህባ ግልጋሎት ጥዕና ንምምሕያሽ ኣብ ሃገርና (ኢትዮጵያ) ብ1994-1995 (ብአቆፃፅራ ግእዝ) ዝተኣታተወ ፕሮግራም ምግፋሕ ጥሙር ጥዕና ቤተሰብ (Health Extension Program/HEP) 10 ዓመታት ኣሕሊፉ ይርከብ፡፡ ፕሮግራም ምግፋሕ ጥሙር ጥዕና (HEP)፣ ሕብረተሰብ መሰረት ዝገበረ-ምክልኻል ሕማማትን ምስጓም ጥዕናን - ምትእትታው ግልጋሎት ሕክምና ቀለልቲ ሕማማትን ብፍላይ ድማ ንኣዴታትን ህፃናትን ትኹረት ብምግባር ስድራ ቤት ብምሕቋፍ ዝንቀሳቐስ ፕሮግራም እዩ፡፡ እዚ ፕሮግራም ንምትግባር ኣብ ክልል ትግራይ ልዕሊ 600 ኬላታት ጥዕና ተሃኒፀን፡፡ ልዕሊ 1200 ሞያተኛታት ጥሙር ጥዕና እውን ሰልጢነን እየን፡፡ ክልተ ሞያተኛታት ኣብ ሓደ ኬላ ጥዕና ተመዲበን ካብ 5000-7000 በዝሒ ንዘለዎ ሕብረተሰብ ግልጋሎት እናሃባ ይርከባ፡፡ እንተኾነ ግን ዝተፈላለዩ መፅናዕታታት ከምዘመላኽትዎ ግልጋሎት ኣዴታት ጥዕና (ወሊድን ድሕሪ ወሊድን) ትሑት ሽፋን ከምዘለዎ ይሕበር፡፡ ዕላማ እዚ ዝገበርናዮ መፅናዕቲ እውን ኩነታት እቲ ግልጋሎት ብኣሃዝ ንምዕቃንን ከምኡ እውን ምኽንያታት እቲ ትሑት ግልጋሎት ንምድህሳስን እዩ፡፡ ኣብዚ መፅናዕቲ እዚ ምኽንያታት ትሑት ሽፋን ግልጋሎት ክንክን ጥንሲ ወሊድን ድሕረ ወሊድን እንታይ ምዃኑ ካብ ሕሉፍ ልምዲ (ተሞክሮ) ኣዴታትን ሰብ ሞያ ጥዕናን ብዝርዝር ብምድህሳስ - ፕሮግራም ምግፋሕ ጥሙር ጥዕና ንቐረብ ግልጋሎት ኣዴታት ጥዕና ንምምሕያሽ ዘለዎ ኣስተዋፅኦ እንታይ ከምዝመስል ተተንቲኑ ቐሪቡ ኣሎ፡፡ እቲ ቀረብ ግልጋሎት ጥዕና ሓሙሽተ መዐቀኒታት ብዘለዎ ፍሬም ዎርክ እዩ ተዳህሲሱ እቶም ሓሙሽተ መመዘኒታት 1. ቅርበት ትካል ጥዕናን ሰብ ሞያ ጥዕናን ንተገልገልቲ 2. ህልውነት ሰብ ሞያ ጥዕናን ናውትን ድሌት ተገልገልትን 3. ሰብ ሞያ ጥዕና ብተገልገልቲ ዘለዎም ተቐባልነት 4. ትካል ጥዕና ንድሌት ተገልገልቲ ንምዕጋብ ዘለዎ ድልውነት 5. ተገልገልቲ ወፃኢታት ሕክምና ንምሽፋን/ንምኽፋል ዘለዎም ድሌትን ዓቕምን እዮም፡፡ እዞም ሓሙሽተ መዐቀኒታት መሰረት ዝገበሩ ኣርባዕተ ዓይነታዊን አሃዛዊን ሜላታት ብምጥቃም ዝተኻየዱ መፅናዕትታት ኣብ ኣብ 4ተ ወረዳታት ትግራይ እዮም ተኻይዶም፡፡ ኣብቲ ቀዳማይ መፅናዕቲ ፕሮግራም ምግፋሕ ጥሙር ጥዕና ቤተሰብ (HEP) ኣብ ምምሕያሽ ክንክን ጥንሲ-ወሊድን-ድሕረ ወሊድን ግልጋሎት ዘምፅኦ ለውጢ ኣብ ሰለስተ ወረዳታት (ጋንታአፈሹም፤ ክልተ ኣውላዕሎ፣ ሕንጣሎ ዋጅራት) ንዝሓለፉ 10 ዓመታት ኣብ ዝተዋህበ ግልጋሎት ብምድራኽ እዩ ዳህሰሳ ተኻይዱ፡፡ ትኽክለኛነት እቲ ፀብፃብ እውን ካብ ትካላት ጥዕና ዝተልኣኸ ወርሓዊ ኣብ ወረዳ ምስ ዘሎ ፀብፃብ ብምንፅፃር ንኽረጋግፅ ተገይሩ እዩ፡፡ እቲ ካልኣይ መፅናዕቲ ኣብ ወረዳ ሰሓርቲ ሳምረ ካብ 19 ጣብያታት ካብ ዝተመረፃ 30 ቑሸታት ዕድሚአን ካብ 15-49 ዓመት ምስ ዝኾና 1115 ደቂኣንስትዮ ኣስታት 30 ደቓይቕ ዝወደአ ቃለ መሕትት ብምኽያድ እዩ ዳህሰሳ ተኻይዱ፡፡ ኣብ ወሊድ ግልጋሎት ዘሎ ልምድን ተሞክሮን ንምድህሳስ 51 ኣዴታት ዝተሳተፋሉ ሽዱሽተ ጉጅላዊ ምይይጥ በቲ ሳልሳይ መፅናዕቲ ምርምር ዝተፈፀመ እንትኾን ምስ ሸሞንተ ሞያተኛታት ጥሙር ጥዕናን ኣርባዕተ ነርስ መዋልዳንን ቃለ መሕትት ብምኽያድ እቲ 4ይ ምርምር/መፅናዕቲ ተፈፂሙ እዩ፡፡ ውፅኢት ቀዳማይ መፅናዕታዊ ፅሑፍ ኣብዚ ቐዳማይ መፅናዕቲ እቶም ዝተአከቡ መረዳእታት ኣብ ሰለስተ ደረጃታት - ቅድመ ፕሮግራም-ፕሮግራም-ድሕረ ፕሮግራም ብዝብል ዝተመቐሉ እዮም፡፡ እቲ ቐንዲ ዕላማ ፕሮግራም ምግፋሕ ጥሙር ጥዕና ድሕሪ ምጅማር ዝተራእየ ለውጢ ንምፍታሽ እዩ፡፡ ኣብ ድሕሪ እቲ ፕሮግራም ካብ 2001-2004 ዓ/ም ብዝተኻየዱ ንጥፈታት ጥዕና ግልጋሎት ወሊድን ድሕረ ወሊድን ኣብ ኩለን ትካላት ጥዕና ካብ ዓመት ናብ ዓመት ልዑል ኣዝማሚያ እናርኣየ ከምዝኸደ ብስታቲስቲካዊ መረዳእታ ንምርግጋፅ ተኻኢሉ እዩ፡፡ ብተመሳሳሊ ኣብዚ ወቕቲ እዚ ኣዝማሚያ ግልጋሎት ክንክን ጥንሲ ኣብ ጥዕና ጣቢያታት ጥራሕ እናለዓለ ከምዝኸደ ውፅኢት እቲ መፅናዕቲ የረድእ፡፡ እቲ መፅናዕቲ ከም ዘረድኦ ሽፋን ክንክን ጥንሲ ብ1995 ካብ ዝነበሮ 28.2% ብ2004 ናብ 46.7 ክምዝለዓለ፤ ግልጋሎት ወሊድ ብ1995 ካብ ዝነበሮ 5% ዝነበረ ናብ 23% ከምዝደየበ ድሕረ ወሊድ ግልጋሎት እውን 11% ዝነበረ ናብ 41% ከምዝለዓለ ንምርዳእ ተኻኢሉ ኣሎ፡፡ ውፅኢት ካልኣይ መፅናዕታዊ ፅሑፍ ኣዴታት ግልጋሎት ክንክን ጥንሲ ኣብ ጥዕና ጣቢያ ንኽጥቀማ ቅርበት ትካላት ጥዕና ንመንበሪ ገዛውቲ፣ ሓዳር ምግባር፣ ልዕሊ 5 ዓመት ስሩዕ ትምህርቲ ምምሃርን ካብ ሕርሻ ወፃኢ ኣብ ካልእ ስራሕቲ ዝተዋፈሩ ሰብ ሓዳር ምህላው ወሰንቲ ኣካላት ምዃኖም በቲ ዝተገብረ ካልኣይ መፅናዕቲ ተረጋጊፁ፡፡ ብተመሳሳሊ ኣብ እዋን ክንክን ጥንሲ ንኣዴታት ምኽሪ ግልጋሎት ምሃብ ቅድመ ታሪኽ ዝንጉዕ ሕርሲ ወይ ሃልኪ ምንባር እውን ኣብ ትካላት ጥዕና ወሊድ ግልጋሎት ንኽመሓየሽ ወሰንቲ ኩነታት ከምዝኾኑ በቲ መፅናዕቲ ተረጋጊፁ፡፡ ብሓፈሻ ፕሮግራም ምግፋሕ ጥሙር ጥዕና ቤተሰብ (HEP) ቀረብ ግልጋሎት ጥዕናን ሽፋን ክንክን ጥንሲ ወሊድን ድሕረ ወሊድ ግልጋሎትን ኣብ ምምሕያሽ ዝተፃወቶ ተራ ትርጉም ዘለዎ ምዃኑ በቲ ዝገበርናዮ መፅናዕቲ ንምርዳእ ተኻኢሉ ኣሎ፡፡ እንተኾነ ግን ባህላዊን ልማዳዊን ኩነታት (ኣብ ገዛ ክትወልድ ምድላይ- ነፍሰፁር ዓይኒሰብ ከይረኽባ ኢልካ ምእማን) - ተበቲኖም ዝሰፈሩ ነበርቲ ምህላው - ኣፀገምቲን ዓቐብ ቁልቁልን ጎቦታትን ዝበዝሖም መንገድታትን እኹል መጉዓዝያ ዘይምህላውን ቀንዲ ሃልኪታትን ዕንቅፋታትን እቲ ዝወሃብ ግልጋሎት ምዃኖም ኣብዚ መፅናዕቲ ተገሊፁ እዩ፡፡ ብተወሳኺ ኣብ ላዕለዎት ትካላት ጥዕና ዘይብሩህ ገፅን ሰሓባይ ኣቀራርባ ሰብ ሞያ ጥዕና ዘይምህላውን ተቐባልነት ዘይብሎም ባህሪያት ምንፅብራቕን ነቲ ግልጋሎት ዝዓዘዘ ዕንቅፋት ከምዘለዎ በቲ መፅናዕቲ ንምርዳእ ተኻኢሉ እዩ፡፡ ማይን መብራህትን ዝኣመሰሉ ትሕቲ ቕርፂ ኣብ ኬላታት ጥዕና ዘይምህላዉ ኣዴታት ኣብ ቀረበአን ዘሎ ትካል ጥዕና ንኽወልዳ ዘየተባብዕ ከምዝኾነ እውን ተሓቢሩ እዩ፡፡ ውፅኢት ሳልሳይን ራብዓይን መፅናዕታዊ ፅሑፍ ኣብ ሳልሳይ መፅናዕቲ ምስ ኣዴታት ብዝተገበረ ምይይጥ - ኣደ እትወልደሉ ቦታ ባዕላ ንኽትውስን ከምእነሓጎታት ዝመሰላ ዕድመ ዝደፍኣ ኣዴታትን ፀቕጢ (ተፅእኖ) ከምዝግበረላ እቶም መፅናዕቲታት ይሕብሩ፡፡ ዋላ አኳ ኣብ ትካል ጥዕና ብዛዕባ ምውላድ ኣዎንታዊ ኣረኣእያ ኣዴታት ዝዓዘዘ እንተኾነ ብዛዕባ ድኹም ኣዋህባ አገልግሎት ጥዕና ኣዝዩ ከምዘተሓሳስበን እቲ መፅናዕቲ ይገልፅ፡፡ ትካል ጥዕና ናብ መንበሪ ኣዴታት ዘለዎ ርሕቐትን መጓዓዓዚ ዘይምርካብ ዝኣመሰሉ ፀገማት ከምዘገድስወን እውን እቲ መፅናዕቲ ይሕብር፡፡ ኣብቲ ራብዓይ መፅናዕቲ ብወገን ሞያተኛታት ጥሙር ጥዕናን ነርስ መዋልዳንን ብዝተገበረ ምይይጥ - ኣብ ሆስፒታል ዝዋሃቡ ዝሐሹ ግልጋሎት ኣዴታት ካብ ታሕተዋይ ትካል ጥዕና ናብ ሆስፒታላት ሪፈር እንትበሃላ ኣብ ምጉዕዓዝ ብሕብረተሰብ ዝግበር ምትሕግጋዝ ከምኡ እውን እናዓበየ ዝኸይድ ዘሎ ግንዛበ ሕብረተሰብ ኣዴታት ኣብ ትካል ጥዕና ንኽወልዳ መሳለጢ ከምዝኾነ እቲ ፅንዓት የረድእ፡፡ ዓቕሚ ምንኣስ ሞያተኛታት ጥሙር ሞያተኛታት ጥሙር ጥዕናን ነርስ መዋልዳንን - ድኹም ኩነታት ትካል ጥዕናን (ሕፅረት ናውቲ ጥዕና ምህላዉ - ትሕቲ ቅርፂ ዘይምምላእ) ፀገም መጉዓዝያን እውን ኣዴታት ኣብ ትካል ጥዕና ንኸይወልዳ ዕንቅፋታት ከምዝኾነ እቲ ፅንዓት የመላኽት፡፡ መጠቓለሊ እቶም ዝተጠቐሱ ዕንቅፋታትን ፀገማትን ብምንካይ ቀረብ ወሊድ ግልጋሎት ጥዕና ንምዕባይ እዞም ዝስዕቡ ፃዕሪታት ምክያድ ይግባእ፡፡ ኣብ ጎቦታትን ኣዝዩ ርሑቕን ኣፀገምትን ዝሰፈረ ሕብረተሰብ ካብቲ ልሙድ ዝተፈለየ ቀረብ ግልጋሎት ጥዕና ምሃብ (ንኣብነት ካብ ጥዕና ጣቢያ ኣዝየን ዝርሕቓ ኬላታት ጥዕና ክእለት ዘለወን ነርስ መዋልዳን (midwives) ምምዳብ - ኣደ ማእኸል ዝገበረ ግልጋሎት ንኽወሃብ ሰብ ሞያ ጥዕና ብዓቕሚ ንኽዓብዩ ምግባርን ነቶም ሓሙሽተ መዐቀኒታት ቀረብ ግልጋሎት ብምምላእ ኣብቲ ሕብረተሰብ ተቐባልነት እቲ ግልጋሎት ክዓቢ ምግባርን፡፡

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Jumare, Fadila. "Factors influencing utilization and adherence to Prevention of Mother to Child Transmission of HIV/AIDS services in Rivers State, Nigeria". Doctoral thesis, Faculty of Humanities, 2019. http://hdl.handle.net/11427/31221.

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Effectiveness of services for Prevention of Mother to Child Transmission (PMTCT) of Human Immunodeficiency Virus (HIV) depends on viable and efficient health systems, adherence to and utilization of services. Despite strategies to provide access to PMTCT of HIV services, utilization of these services remain low in Nigeria thereby increasing child morbidity and mortality from HIV-related causes. Adherence to comprehensive HIV/AIDS care, for both the mother and baby, remain a challenge for HIV positive women. Utilizing the Health Belief Model and Social Support Theory, this qualitative study explores factors influencing utilization and adherence to PMTCT services by mothers living with HIV/AIDS in Rivers State, Nigeria. Purposive sampling procedures were used to select 40 study participants including 20 HIV positive mothers and 20 health care workers as key informants. Findings indicate that high self-perceived susceptibility to HIV influences utilization and adherence to PMTCT services among mothers living with HIV and AIDS in Rivers State. Although utilization and adherence to PMTCT were reported very high among this population, there were however challenges and barriers to optimal utilization of PMTCT. These include unavailability of test kits, antiretroviral medication stock-outs, and inadequate human resources for health. High transport, PMTCT and antenatal care costs were identified as the major socio-economic barriers to PMTCT administration as well as the high financial burden of formula feeding for women that preferred exclusive formula feeding. In addition to increased numbers of health care workers trained in PMTCT service delivery, recommendations for a public health approach to service delivery and a streamlined primary care strategy are proposed. These include social and community activities to address HIV/AIDS stigma, improving awareness of PMTCT facts, addressing gender relations and encouraging male participation. Inter-ministerial collaborations and targeted partnerships are also recommended for expanding coverage and ensuring optimal utilization of PMTCT services.

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27

Edvardsson, Kristina, Anneli Ivarsson, Rickard Garvare, Eva Eurenius, Marie Lindkvist, Ingrid Mogren, Rhonda Small y Monica E. Nyström. "Improving child health promotion practices in multiple sectors : outcomes of the Swedish Salut Programme". Umeå universitet, Epidemiologi och global hälsa, 2012. http://urn.kb.se/resolve?urn=urn:nbn:se:umu:diva-60853.

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Background: To improve health in the population, public health interventions must be successfully implemented within organisations, requiring behaviour change in health service providers as well as in the target population group. Such behavioural change is seldom easily achieved. The purpose of this study was to examine the outcomes of a child health promotion programme (The Salut Programme) on professionals' self-reported health promotion practices, and to investigate perceived facilitators and barriers for programme implementation. Methods: A before-and-after design was used to measure programme outcomes, and qualitative data on implementation facilitators and barriers were collected on two occasions during the implementation process. The sample included professionals in antenatal care, child health care, dental services and open pre-schools (n=144 pre-implementation) in 13 out of 15 municipalities in a Swedish county. Response rates ranged between 81% and 96% at the four measurement points. Results: Self-reported health promotion practices and collaboration were improved in all sectors at follow up. Significant changes included: 1) an increase in the extent to which midwives in antenatal care raised issues related to men's violence against women, 2) an increase in the extent to which several lifestyle topics were raised with parents/clients in child health care and dental services, 3) an increased use of motivational interviewing (MI) and separate 'fathers visits' in child health care 4) improvements in the supply of healthy snacks and beverages in open pre-schools and 5) increased collaboration between sectors. Main facilitators for programme implementation included cross-sectoral collaboration and sector-specific work manuals/questionnaires for use as support in everyday practice. Main barriers included high workload, and shortage of time and staff. Conclusion: This multisectoral programme for health promotion, based on sector-specific intervention packages developed and tested by end users, and introduced via interactive multisectoral seminars, shows potential for improving health promotion practices and collaboration across sectors. Consideration of the key facilitators and barriers for programme implementation as highlighted in this study can inform future improvement efforts.

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Workneh, Nibretie Gobezie. "Socioeconomic Status-Related Inequities on Maternal Health Services: Trends, Associations, and Outcomes". ScholarWorks, 2016. https://scholarworks.waldenu.edu/dissertations/2246.

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Maternal Mortality Rate (MMR) in Ethiopia remains one of the highest in the world due in part to very limited use of maternal health services. However, the underlying factors for limited use of the services and hence the high MMR are not well known. The purpose of this study was to identify factors associated with use of maternal health services and maternal health risks, to analyze inequity patterns between use of maternal health services and maternal health risks, and to measure the magnitude and trends in inequity. Behavioral-cultural and structural theories of health inequalities were used to frame the study. Research questions included whether there were trends of inequity in use of maternal health services, if sociodemographic characteristics were associated with use of the services, and whether inequities in use of the services were associated with maternal health risks. The study design was quantitative and used data collected through Demographic and Health Surveys (DHS) conducted in 2000, 2005, and 2011. DHS had employed stratified 2-stage cluster design; this analysis used logistic regression method, odds ratio chi-square test, and correlation measures. The findings indicated statistically significant inequities on use of antenatal care and skilled birth attendant services associated with women's residence, level of education, income, administrative region, distance to a health facility, out-of-pocket payment for health services, and involvement in decision making. Based on the findings, it is recommended to design maternal health policies and programs that improve access and use of the services, specifically for women in rural areas, with no education and with limited economic capacity. Further research is also recommended for regions where sample size was limited. Maternal health policies and programs designed to reach the most disadvantaged women could increase service use and improve maternal health, leading to positive social change.

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Musana, Imelda Atai Madgalene. "Effect of Access to Health Services on Neonatal Mortality in Uganda". ScholarWorks, 2019. https://scholarworks.waldenu.edu/dissertations/7828.

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Since 2006, Uganda has experienced a nonchanging neonatal mortality rate of 27 out of 1,000 live births, which is higher than the global average of 19 deaths for every 1,000 live births. The purpose of this retrospective cross-sectional study was to determine factors affecting access to health services and their impact on newborn deaths in Uganda. Mosley and Chen's model for child survival in developing nations provided the framework for the study. Secondary data from the 2016 demographic and health survey (UDHS) collected by the Uganda Bureau of Statistics (UBOs) was used. A total of 7,538 cases were used and analyzed using binary logistic regression and one-way analysis of covariance (ANCOVA). The results showed attending less than 4 antenatal care (ANC) visits during pregnancy increased the odds of neonatal deaths 1.57 times, while not taking antimalarial drugs during pregnancy increased the odds of neonatal deaths 1.67 times. However, receiving 4 or more tetanus toxoid (TT) vaccine doses before pregnancy was not statistically associated with an increased risk of neonatal death (p = .597). Also, there was no significant relationship between neonatal mortality and whether distance to health facilities was a challenge (p = .276) or receiving medical assistance during childbirth (p = .420). While there were significant differences in deaths of newborns in geographic regions while controlling for the number of ANC visits (p = .023), there were no differences while controlling for all three covariates, F(4, 117) = 2.00, p = .098. Findings may be used to inform government policies on ANC and malaria prevention during pregnancy, which may reduce neonatal mortality rates in Uganda.

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Behumbiize, Prosper T. "Factors influencing male’s involvement in prevention of mother to child transmission (PMTCT) services in Kibaale District, Uganda". UWC, 2009. http://hdl.handle.net/11394/2683.

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Magister Public Health - MPH
Globally, approximately 600,000 infants each year are born with HIV infection in Sub-Saharan Africa as a result of mother to child transmission (MTCT) (UNAIDS, 2001). Whereas there is significant progress in reduction of mother to child transmission of HIV in Uganda, the Western Region of Uganda has low rates of PMTCT service utilization. The progress has been hampered by many factors including low male involvement (MOH, 2005). The main objective of this study was therefore to identify some of the factors that discourage men from participating in PMCT services in this region. The study was conducted in Kibaale District in the Western Region of Uganda for a period of one month in mid 2009. Data was collected using a qualitative methodology. The tools that were used for data collection were key informant in-depth interviews and focus group discussions (FGDs) guides. Data was collected from PMTCT service providers, women of reproductive age group and men whose partners had given birth during the last year (2008). For the focus groups, a purposive sample of men and women who had some children born in 2008, followed by random sampling from the list of potential subjects was used to select participants. The study sample comprised of three FGDs of women who had given birth in year 2008 and male partners of women who had also given birth in 2008. Each FGD consisted of eight participants. One FGD was with women only, the other with men only, while the third was with both men and women.

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Urassa, David Paradiso. "Quality Aspects of Maternal Health Care in Tanzania". Doctoral thesis, Uppsala : Acta Universitatis Upsaliensis : Univ.-bibl. [distrubutör], 2004. http://urn.kb.se/resolve?urn=urn:nbn:se:uu:diva-4221.

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Mwale, Ackson Tyson. "Women’s empowerment and use of Maternal Health Services in Zambia in 2010s". Thesis, Stockholms universitet, Sociologiska institutionen, 2018. http://urn.kb.se/resolve?urn=urn:nbn:se:su:diva-158073.

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This study investigates the influence of women’s empowerment measured via spousal educational difference and women’s completed education level on the use of maternal health services (Antenatal care and skilled birth assistance), and whether it varies by ethnicity. A theoretical framework based on Kabeer’s three dimension of empowerment combined with Zimmerman’s approach and the rational choice theory informs the analyses. Data from the 2013/2014 Zambia Demographic and Health survey are analysed focusing on women aged 15 -49 years who are married/ live with a partner and had a birth in the past five years. Multivariate logistic regression is the tool of analysis.The results indicate significant association between women’s completed education level and use of maternal health services. Spousal educational differences show no significant association with the use of MH services. For both ANC and SBA use, a relatively weak relationship is seen with ethnicity. In addition, women’s wealth level, the province they live in and region of residence type appear to be important with respect to the utilization of MH services. The findings are explained in relation to the theoretical framework as well as previous studies, concluding the study with suggestions for further research.

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33

Saleh, Jalal-Eddeen Abubakar. "Prevalence of Neonatal Tetanus in Northeastern Nigeria". ScholarWorks, 2014. https://scholarworks.waldenu.edu/dissertations/166.

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Although efforts have been made towards improving the health of children across the globe with notable results, neonatal tetanus (NNT) remains a major contributor to the neonatal death rates in Nigeria. This problem calls for a concerted effort by the government to achieve the revised global NNT elimination deadline of 2015. The purpose of this cross-sectional quantitative study using secondary data was to establish the prevalence of NNT in Nigeria's northeast region and to ascertain if there was any significant difference in frequency of antenatal care (ANC), trained traditional birth attendants (TBAs), and umbilical cord treatments, using single sample proportions test and chi-squared tests of independence. The framework for this research was the theory of planned behavior. The participants (N = 312) were mothers of NNT babies. In spite a continual decline in the NNT cases between 2010 (26%) and 2013 (9%), the prevalence rate of NNT was unacceptably high at 28.815%. Also, significant differences existed as mothers who gave birth to NNT babies received significantly fewer or no ANC (p < 0.001), received significantly fewer or no attention from TBAs (p < 0.001), and reported significantly fewer incidences of proper umbilical cord treatments (p < 0.001). The chi-squared tests of independence resulted in significant differences in the frequencies of mothers who received ANC between Nigerian provinces (p < 0.001) and mothers who had their baby's umbilical cord treated (p = 0.005). This study will contribute to social change by guiding health care policy makers and immunization program managers on maternal and newborn health care services and indicate ways to build capacity of the TBAs for safe home delivery/hygienic handling of umbilical cord of newborns.

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Graner, Sophie. "Reproductive outcomes in rural Vietnam. Perspectives and experiences by pregnant women and health care professionals on pregnancy promotion and maternal health care". Doctoral thesis, Umeå universitet, Obstetrik och gynekologi, 2010. http://urn.kb.se/resolve?urn=urn:nbn:se:umu:diva-37266.

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Background Reproductive health and health events associated with pregnancy including induced abortions are among the most important factors for the health of fertile women. Adverse outcomes have an impact on women’s reproductive health and their overall health as well as the health of their offspring. Pregnancy and child bearing take place within a cultural context. Risk factors for adverse pregnancy outcomes depend on factors both associated with the individual woman as well as contextual factors. Aims This thesis investigates reproductive health indicators and their determinants for women in a rural district in Vietnam with special focus on adverse pregnancy outcomes and their determinants. In addition, this thesis explores the perspectives and experiences among pregnant women and health care professionals on maternal health care in Vietnam and risks during pregnancy and delivery. Methods The studies used quantitative and qualitative methods. In the quantitative studies a total of 4,396 women reporting 5,838 pregnancies, and 5,521 infants were included. Parametric and non parametric tests and univariate and multivariate logistic regression analysis was performed. For the estimation of small for gestational age a population-specific reference curve was constructed based on the mean birth weight at term in the study population. In the qualitative studies data were collected from eight focus group discussions, four with pregnant women and four with health care professionals. Manifest and latent content analysis was applied. Main findings Women belonging to an ethnic minority or women giving birth at home were at increased risk of stillbirth. The risk of induced abortion increased with maternal age. Neonatal mortality was estimated to 11.6 per 1000 live births and perinatal mortality to 25.0 per 1000 births. The prevalence of small for gestational age was estimated to 6.4%. Risk factors for small for gestational age included women in farming occupations and post-term birth. There was a marked decrease in perinatal mortality after 33 weeks of gestation. Contextual conditions influenced both pregnant women’s use of maternal health care and the performance of the health care professionals. The use of maternal health care was influenced by economical conditions as well as cultural norms that impeded women’s autonomy. Structural constraints included inadequate financing of the health system, including lack of staff, insufficient professional re-training, and inadequate equipment. Pregnant women in rural Vietnam created a strategy to promote a healthy pregnancy through lifestyle adjustments, gathering of information, and seeking timely medical care. Insights in pregnancy-related conditions were sought from various sources and were influenced both by Vietnamese traditions and modern medical knowledge. Conclusions Knowledge about pregnancy complications and their related signs and symptoms, and a high confidence in the maternal health care probably contribute to the relatively good maternal health status and pregnancy outcomes in Vietnam. To improve perinatal and neonatal outcomes there is a need to ensure access for all pregnant women to delivery units with surgical capacity in case of an obstetrical emergency. Also, a higher proportion of premature infants need to be born at units with access to neonatal care. This may be achieved by an improved system for referral including capacity of medical care during transportation. Other desirable improvements include antenatal identification of small for gestational age foetuses. In our study the induced abortion rate increased with maternal age and was highest among married women, indicating that induced abortions may be used as a method for family planning. The cultural norms in Vietnam limit women’s autonomy and reduce their possibility to make independent decisions about their reproductive health. Our studies emphasize the importance of adequate access for all women to maternal health care adjusted for their individual needs. A better understanding is needed of context-specific factors that influence couples’ choice of family planning methods, place of birth, and maternal health care. The communication between pregnant women and health care professionals needs further investigation. This knowledge is essential in order to develop reproductive health services that are accessible, acceptable and affordable to all.

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Darwin, Zoe. "Assessing and Responding to Maternal Stress (ARMS) : antenatal psychosocial assessment in research and practice". Thesis, University of Manchester, 2013. https://www.research.manchester.ac.uk/portal/en/theses/assessing-and-responding-to-maternal-stress-arms-antenatal-psychosocial-assessment-in-research-and-practice(f58f4ced-df4e-49d6-ba08-24f24fade0a5).html.

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Background: Antenatal Psychosocial Assessment (APA) has recently been introduced into routine antenatal care, but the ways in which maternity service providers assess and respond to maternal stress are subject of debate. There is a lack of consensus on the instrument(s) of choice and lack of evidence regarding appropriate interventions. Further, national guidelines have not kept apace with the conceptual shift from ‘postnatal depression’ to ‘perinatal anxiety and depression’. Adopting the Medical Research Council Complex Interventions Framework, the ARMS research aimed to inform the development of interventions that support women who are experiencing, or at risk of, mild-moderate mental health disorder in pregnancy. Methods: A mixed methods approach was adopted. In the quantitative element (Study Part 1) participants (n=191) completed a questionnaire when attending for their first formal antenatal appointment, using a procedure and materials that had been previously tested in a pilot study. Details including mental health assessment and referrals were obtained from their health records, following delivery. In the qualitative element (Study Part 2) a sub-sample of women (n=22) experiencing high levels of maternal stress took part in up to three serial in-depth interviews during pregnancy and the early postnatal period.Findings: Maternal stress was found to be common. Using the Edinburgh Postnatal Depression Scale (EPDS) threshold of ≥10, approximately 1 in 4 women were classed as high depression (halving to 1 in 8 at the more conservative threshold of ≥13). Almost 1 in 3 women were classed as high anxiety, using the state scale of the State-Trait Anxiety Inventory (STAI-S, threshold ≥41), compared with 1 in 5 using the two-item GAD (threshold ≥3). Fewer than half of the women identified as high anxiety were identified by both measures. Factor analyses of the symptom measures were consistent with wider literature suggesting a three-item anxiety component of the EPDS; however, concurrent validation using regression analyses did not indicate that the EPDS could be used as an anxiety case finding instrument. Women reported that maternal stress had significant impact on their lives that may not be captured with existing clinical approaches. Women commonly found it difficult to self-assess severity of maternal stress and the assessment process could itself act as an intervention. The research provided the first validation of the depression case finding questions in UK clinical practice. The Whooley items completed in clinical practice identified only half of the possible cases identified by the EPDS, at both commonly adopted EPDS thresholds. Inclusion of the Arroll 'help' question as a criterion improved specificity of the assessment completed in clinical practice but substantially compromised sensitivity, missing 9 in 10 possible cases. Women’s mental health history and treatment history were similarly under-reported, particularly concerning anxiety. APA was introduced into routine clinical practice without attention to topics of relevance to women, context of disclosure or to provision of adequate resources for consistently responding to identified need. Women experiencing, or at risk of, mild-moderate disorder were thus usually ineligible for further support. Implications: Care pathways are needed that encompass both assessing and responding to maternal stress, where communication with health professionals, subsequent referral and management are addressed. The development, implementation and evaluation of low-cost resources embedded in such pathways are a priority and the research presented in the thesis offers a foundation on which to build.

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Edvardsson, Kristina. "Health promotion in pregnancy and early parenthood : the challenge of innovation, implementation and change within the Salut Programme". Doctoral thesis, Umeå universitet, Epidemiologi och global hälsa, 2013. http://urn.kb.se/resolve?urn=urn:nbn:se:umu:diva-70172.

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Background: In 2005, the Västerbotten County Council launched a child health promotion programme, “the Salut Programme”, in response to an alarming prevalence of overweight and obesity, and trends of increased dental caries, among young county citizens. The programme, initially developed in four pilot areas, is built on multidisciplinary and cross-sectoral collaboration and aims to support and strengthen health promotion activities in health care, social services and school settings. It targets children and adolescents (0-18 years of age) and their parents, and starts during pregnancy. This thesis focuses on interventions provided by antenatal care, child health care, dental services, and open pre-schools, directed to expectant parents and families with children aged 0-1 ½ years. Within the programme context, the aim was to explore socio-demographic patterns of overweight and obesity in expectant parents (Paper I), firsttime parents’ experiences of health promotion and lifestyle change during pregnancy and early parenthood (Paper II), professionals’ experiences of factors influencing programme implementation and sustainability (Paper III and IV), and early programme outcomes on professionals’ health promotion practices and collaboration following countywide dissemination and implementation (Paper IV). Methods and results: A population based cross-sectional study among expectant parents showed overweight and obesity in 29% of women (pre-pregnancy) and in 53% of men (n=4,352♀, 3,949♂). The likelihood for obesity was higher in expectant parents with lower levels of education, among those unemployed or on sick leave, and those living in rural areas. In 62% of couples, at least one of the partners was overweight or obese; a positive partner correlation was also found for BMI (I). An interview study with 24 first-time parents (n=12♀, 12♂) revealed that they primarily undertook lifestyle changes to secure the health of the fetus in pregnancy, and to provide a healthy environment in childhood. Parents described themselves as highly receptive to information about how their lifestyle could influence fetal health, and they frequently discussed pregnancy risks related to tobacco and alcohol, as well as toxins and infectious agents in foods. However, parents did not seem inclined to make lifestyle changes primarily to promote their own health. The antenatal and child health care services were perceived as being mainly directed towards women, and parents described a lack of a holistic view of the family which included experiences of fathers being treated as less important (II). An interview study undertaken with professionals (n=23) in the Salut Programme pilot areas indicated programme sustainability at most sites, two years after implementation, although less adherence was described within child health care. Factors influencing programme sustainability, as described by professionals, were identified at multiple organisational levels (III). A before-and-after survey among professionals (n=144) measured outcomes of the county-wide implementation of the Salut Programme in 13 out of 15 county municipalities. Results showed significant improvements in professionals’ health promotion practices and collaboration across sectors. A number of important implementation facilitators and barriers, acting at different organizational levels, were also identified via a survey comprised of open-ended questions (IV). Conclusion: The Salut Programme, developed with high involvement of professionals, and strongly integrated in existing organisational structures and practices, shows potential for improving health promotion practices and cross-sectoral collaboration. The findings can inform further development of the Salut Programme.as well as new health promotion initiatives, and inform policy practice and future research. These aspects include approaches in health promotion and prevention, father involvement during pregnancy and early parenthood, and factors influencing implementation and sustainability of cross-sectoral health promotion programmes.
Bakgrund: År 2005 lanserade Västerbottens läns landsting en hälsofrämjande satsning “Salut” som svar på en oroande förekomst av övervikt och fetma samt trender till ökad förekomst av karies hos barn i länet. Satsningen, som initialt utvecklades i fyra pilotområden, bygger på tvärprofessionellt och verksamhetsövergripande samarbete och syftar till att stödja och stärka hälsofrämjande insatser inom landstinget och länets kommuner. Satsningen riktar sig till barn och unga (0-18 år) och deras föräldrar, med start under graviditeten. Denna avhandling fokuserar på insatser som erbjuds via mödrahälsovård, barnhälsovård, tandvård och öppen förskola riktade till blivande föräldrar och familjer med barn i åldern 0-1 ½ år. Med utgångspunkt från Salut-satsningen syftar avhandlingen till att undersöka socio-demografiska mönster av övervikt och fetma hos blivande föräldrar (I), förstagångsföräldrars upplevelser av hälsofrämjande insatser och förändrade levnadsvanor under graviditet och tidigt föräldraskap (II), personalens upplevelser av underlättande och hindrande faktorer för satsningens införande och uthållighet (III, IV), samt förändringar i arbetssätt och samarbete mellan verksamheterna efter den länstäckande spridningen av satsningen (IV). Metod och resultat: En populationsbaserad tvärsnittsstudie bland blivande föräldrar visade på övervikt och fetma hos 29% av kvinnorna (vikt före graviditet) och hos 53% av männen (n=4352♀, 3949♂). Lägre utbildningsnivå, arbetslöshet och sjukskrivning samt att bo utanför städerna visade sig öka sannolikheten för fetma. Hos en övervägande del av paren (62%) fanns minst en partner med övervikt eller fetma och samband kunde även påvisas mellan kvinnans och mannens BMI (I). En intervjustudie med 24 förstagångsföräldrar (n=12♀, 12♂) visade att föräldrarna främst förändrade sina levnadsvanor för att säkra hälsan hos fostret under graviditeten och för att skapa en hälsosam miljö för barnet under uppväxten. Föräldrarna beskrev sig själva som mycket mottagliga för information om hur deras levnadsvanor kunde påverka fostrets hälsa och de diskuterade ofta graviditetsrisker i relation till tobak och alkohol samt gifter och smittoämnen i livsmedel. Föräldrarna var dock mindre angelägna att förändra sina levnadsvanor med tanke på sin egen hälsa. De upplevde att mödrahälsovårdens och barnhälsovårdens insatser i huvudsak riktades till kvinnor och beskrev en avsaknad av helhetssyn på familjen, vilket även avspeglades i upplevelser av att papporna behandlades som mindre viktiga (II). En intervjustudie med personal (n=23) inom pilotområdena, två år efter utveckling och införandet av Saluts insatser, indikerade god uthållighet av satsningen, även om en lägre följsamhet till insatserna beskrevs inom barnhälsovården. Faktorer som av personalen beskrevs påverka uthålligheten identifierades på flera organisatoriska nivåer (III). En före- och efterstudie bland personal (n=144) mätte effekter av den länstäckande spridningen av satsningen i 13 av länets 15 kommuner. Resultaten visade på flera signifikanta förbättringar av de hälsofrämjande arbetssätten och ett ökat samarbete mellan verksamheterna. En enkät med öppna frågor riktad till personalen belyste också faktorer på flera organisationsnivåer som ansågs underlätta respektive hindra införandeprocessen (IV). Slutsats: Salut-satsningen, som är utvecklad i nära samarbete med verksamheternas personal och väl integrerad i redan existerande organisatoriska strukturer och arbetssätt, visar på potential att förbättra hälsofrämjande arbetssätt och samarbete mellan verksamheter. Aspekter som beskrivits och diskuterats kan vägleda satsningens fortsatta utveckling såväl som framtida nya initiativ. Resultaten och slutsatserna kan även användas i syfte att påverka policy, praxis och framtida forskning. Detta avser framförallt hälsofrämjande och sjukdomsförebyggande metoder, pappans roll under graviditet och tidigt föräldraskap samt kunskaper om faktorer som kan ha betydelse för genomförande och uthållighet av verksamhetsövergripande hälsofrämjande insatser.

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Ngongo, Ngashi. "Health System Predictors of Antenatal Care Compliance Among Rural Congolese Women". ScholarWorks, 2016. https://scholarworks.waldenu.edu/dissertations/2038.

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Fewer rural Congolese women complete 4 antenatal care (ANC) visits than do urban women, despite high maternal and child mortality rates. This quantitative cross-sectional survey applied Andersen's behavioral model of service utilization to examine whether the ANC facility type, provider type, provider gender, time to ANC facility, cost, and number of services can predict ANC compliance among rural women. The study was a secondary analysis of the 2015 Maternal and Child Health (MCH) survey, which comprised 1,280 eligible women selected through stratified random sampling. The analysis included bivariate and multivariate logistic regressions. The findings showed that women seen in private facilities, AOR = 2.220, 95% CI [1.384, 3.561], p < .01; women seen by female providers, AOR = 1.407, 95% CI [1.055, 1.877], p < .05; and women receiving 7 to 9 ANC services, AOR = 1.680, 95% CI [1.142, 2.472], p < .05, were more likely to complete 4 ANC visits. The cost of services and time to the ANC facility had no association with ANC compliance. Further analysis showed that private facilities provided more services (median of 6 vs. 5, p = .000) and had more women attended to by doctors (11% vs. 2%, p = .000) and female providers (72.9% vs. 58.4%, p < .001). These findings suggest that service quality and provider gender play a role in ANC compliance in rural areas. Therefore, Congolese health authorities should establish quality improvement programs and incentives to attract female providers to rural areas. This study contributes to positive social change by identifying ANC access barriers of rural populations and informing future efforts to close the urban-rural gap in MCH outcomes.

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Paul, Pooja Lilly. "Gatekeepers or Equal Partners?: An Examination of Male Partner Attendance in Antenatal Care". Thesis, Boston College, 2021. http://hdl.handle.net/2345/bc-ir:109137.

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Thesis advisor: Shanta Pandey
A growing body of literature, particularly from low and middle-income countries, has focused on the role of male involvement in maternal care as a crucial strategy to improve maternal and neonatal health outcomes. The purpose of this three-paper dissertation is to add to this evidence base within the context of India, and to gain an in-depth understanding of one aspect of male involvement – that is, male partner attendance in antenatal care. This dissertation utilized data from the National Family Health Survey (NFHS-3, 2005-06 and NFHS-4, 2015-16) and was framed using the Social Ecological Model, Connell’s Theory of Gender and Power and a Gender-Transformative lens. Paper 1 summarized the levels of male partner attendance in antenatal care and assessed changes over time. Further, multivariable logistic regression models were used to examine the factors influencing male partner attendance in antenatal care. The results show an overall increase in male partner attendance in India during the period of 2005-06 to 2015-16, with the Southern region reporting the highest level of male partner attendance in both years. Higher level of education and household wealth, increased knowledge of pregnancy-related complications, older age at marriage, and women’s autonomy were positively associated with male partner attendance in antenatal care. Paper 2 examined the association between male partner attendance in antenatal care and maternal health service utilization. Controlling for all socio-demographic variables and adjusting for report of pregnancy complications, the results showed that women who were accompanied by a male partner for antenatal care reported increased odds of maternal health service utilization (early initiation of antenatal care, frequency of antenatal care contacts and institutional delivery). While the place of residence (rural/urban) did not influence the association between male partner attendance and maternal health service utilization, region had a significant moderating effect. Paper 3 examined the association between antenatal care and infant birth weight, adjusting for gestational age. Further, the analysis also assessed whether the relationship between antenatal care and infant birth weight varied by male partner attendance. Findings indicate that early initiation of antenatal care and maternal immunization was associated with reduced odds of low birth weight among infants. The results showed that male partner attendance in antenatal care did not have a moderating influence. Taken together, the findings of the three papers have implications for policy and practice; further, they provide support for interventions that aim for a more inclusive and gender-transformative approach to maternal and neonatal health
Thesis (PhD) — Boston College, 2021
Submitted to: Boston College. Graduate School of Social Work
Discipline: Social work

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Saroj, Prasad Orapin Singhadej. "A comparative study of knowledge, attitude and practice of women in reproductive age, concerning maternal and (antenatal care) child health care activities with blue card and without blue card program in Ratchaburi province /". Abstract, 1988. http://mulinet3.li.mahidol.ac.th/thesis/2531/31E-Saroj-P.pdf.

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40

Effendi, Rustam Sirikul Isaranurug. "Factors related to regular utilization of antenatal care service among postpartum mothers in Pasar Rebo General Hospital Jakarta, Indonesia /". Abstract, 2008. http://mulinet3.li.mahidol.ac.th/thesis/2551/cd414/5037986.pdf.

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Dzokoto, Agnes Wilhelmina. "Performance, utility and cost-effectiveness of a point-of-care test for antenatal syphilis screening at the primary level of the health service in Ghana". Thesis, London School of Hygiene and Tropical Medicine (University of London), 2012. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.590617.

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Kirya, Viola. "A mixed methods study to explore the outcomes, experiences and perceptions of women who attended a new counselling model for HIV-positive pregnant women accessing antenatal services in Khayelitsha, Cape Town, South Africa". Master's thesis, University of Cape Town, 2016. http://hdl.handle.net/11427/21194.

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Objectives: The aim of this study was to explore the experiences and perceptions of counsellors and patients towards a new counselling model for HIV-positive pregnant women on Option B+ at an antenatal clinic in South Africa and to describe the cohort of HIV-positive pregnant women who experienced the new counselling model. Methods: A mixed methods study design was employed. The quantitative data collection involved using retrospective cohort quantitative data of women that were initiated on Option B+ during the period of 1 October 2013 to 30 June 2014. The variables of interest included: age, gravidity, antiretroviral therapy initiation date, viral load result and number of counselling sessions completed. These were obtained from patient folders and from the Department of Health patient electronic health record. The data was analysed using STATA 12. The qualitative data involved semi-structured interviews of patients and counsellors who had experienced the counselling model. Results: The number of women who completed a total of 1, 2, 3 or 4 counselling sessions was 25%, 26%, 48% and 1% respectively. The percentage of women that were retained in care for more than 8 weeks postnatal was 53%. Of the women with VL results, 92% were virally suppressed. The Fisher's exact test showed a P-value of 0.05 at a level of significance of P ≤ 0.05. Therefore there is sufficient evidence to show that there is a positive association between the number of counselling sessions completed and number of postnatal days in care. The study also found that from the counselling, the women gained social support, knowledge about: antiretroviral therapy, HIV, drug side effects and infant feeding. Conclusion: The poor uptake of the counselling intervention includes poor communication, service delivery challenges and social factors. The main motivation for initiating ART and maintaining adherence to treatment was to protect the baby and as a result, some women maintained adherence despite not completing the counselling. Women valued the education that they received during the counselling sessions and this influenced their adherence. Psychosocial support from the counsellors and peers was found to be vital to the women and this highlighted the need to incorporate a support group for the pregnant women, as part of the intervention. The findings also suggest that when offering counselling interventions to pregnant women, a balance between psychosocial support, practical support and patient education needs to be struck. Finally, education of the community on the importance of counselling is important in order to improve the uptake of the counselling because interventions aimed at mothers do not always take into account the influence of the social environment on the uptake of the intervention.

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Nichols, Catherine Selden. "Closing the HIV Testing and Counseling (HTC) Gap| Examining How the HTC Service Environment Impacts Recent Testing Uptake and the Factors Associated with Routine HTC in Antenatal Care (ANC) Settings Using Nationally-Representative Household and Facility Surveys from Kenya, Tanzania and Uganda". Thesis, The George Washington University, 2018. http://pqdtopen.proquest.com/#viewpdf?dispub=10786259.

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The path to controlling the global HIV/AIDS epidemic and achieving the UNAIDS goals of 90-90-90 is hampered by the need to identifying people living with HIV (PLHIV) through HIV testing and counseling (HTC) services. Improving access to HTC services is important because the early identification of HIV-positive individuals can facilitate their access to and enrollment in life-long HIV prevention and treatment services, which can lead to significant reductions in morbidity and mortality. HTC is also a cornerstone of prevention of mother-to-child (PMTCT) programs and can protect the health of pregnant women and their babies. Yet gaps remain in the uptake of HTC, particularly in sub-Saharan Africa where the more than 50% of PLHIV reside. Compounding this problem, there is a dearth of evidence on key operational challenges and the quality of services administered to people in low- and middle-income countries that may impede the delivery of HTC at health care facilities. This dissertation, which is comprised of two analyses, seeks to help fill that gap.

I examined the association between the regional HTC service environment and recent HIV testing behaviors among adults and the determinants of routine HIV testing in antenatal care (ANC) settings using nationally-representative datasets from East Africa. The first objective of this dissertation was to examine the association between HTC service readiness and HTC standard precautions and uptake in HIV testing and counseling by linking data from the Demographic and Health Survey (DHS) and Service Provision Assessments (SPA) from Kenya, Tanzania and Uganda from 2004-2010. The second objective was to determine the frequency of health care providers routinely offering HTC to pregnant women during ANC visits and the facility- and individual-level characteristics of health care providers offering the HIV test, using data from the Kenya 2010 SPA. These population-based analyses provide insight on the degree and extent of HTC program and policy implementation in East Africa, identify how the service readiness of HTC provided at facilities is associated with health-seeking behaviors on an individual level and help to fill an important knowledge gap in HIV implementation research.

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Doriqui, Maria Juliana Rodovalho. "AVALIAÇÃO CLÍNICO-EPIDEMIOLÓGICA DE CRIANÇAS E ADOLESCENTES COM ATRASO GLOBAL DO DESENVOLVIMENTO ATENDIDOS EM SERVIÇO ESPECIALIZADO DE GENÉTICA MÉDICA, SÃO LUÍS-MA". Universidade Federal do Maranhão, 2012. http://tedebc.ufma.br:8080/jspui/handle/tede/1177.

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Made available in DSpace on 2016-08-19T18:16:06Z (GMT). No. of bitstreams: 1 Dissertacao Maria Juliana.pdf: 1730875 bytes, checksum: bb81b2862c7cfd5a83d783a11b1172e9 (MD5) Previous issue date: 2012-06-04
INTRODUCTION: Intellectual disability (ID) occurs in 2-3% of the population and it has a heterogeneous etiology (genetic, environmental or multifactorial). The diagnosis of DI requires use of validated instruments, unavailable for children younger than 5 years, for which reserves the term global developmental delay (GDD). It is essential specialized assessment to the people with GDD /ID, isolated or syndromic, as well as to obtain a detailed overview of factors that may be associated with its onset. OBJECTIVES: To analyze cases of GDD / ID in children and adolescents who attended APAE St. Louis describing the sociodemographic characteristics, conditions of pregnancy, childbirth, the newborn, the clinical evolution and monitoring. METHODS: A quantitative cross-sectional descriptive study. It was collected primary data of 156 patients evaluated at the Medical Genetics Service from this institution in December 2009 to December 2010, and used Windows Microsoft Office Excel 2008 for tabulation and Epi Info 3.5.1 to calculate simple frequencies. RESULTS: It were observed: mean age 36 months, the ratio between males and females of 1.2:1; journal to offset the capital, 20% of cases; parental consanguinity in 4.5%, similar cases in the family 7 %. The mothers, mostly had between 20 and 34 years old, exclusively home occupation, with at least primary education and until two pregnancies. Pregnancy: begun antenatal care until the third month in 63.5% (only 11% in the first month), 14% ethanol exposure, the majority denies exposure to tobacco or drugs inappropriate for pregnancy; and in 60% were referred some eventful; 17.3%, antenatal diagnosis of congenital malformations or infections. Delivery: 88.5% in hospital, 72% at term and 21.8% preterm, 54.5% in vaginal delivery and cesarean section in 35.3%, 86% in cephalic presentation. Conditions of newborns: 39% had hypoxia suspicion, 46.8% required ICU admission, and 44.5% had been hospitalized for more than eight days. Anomalies of the central nervous system (CNS) were found in 61.5%, including those that could be observed by simply measuring head circumference - microcephaly (50%), macrocephaly (5%). Most had no access to basic exams to diagnostic investigation (CNS imaging, karyotype, hearing and vision assessment). CONCLUSIONS: Reiterate the lack of studies on the subject, the inequity of access to diagnosis and treatment, the need for qualification of antenatal and childbirth care, and of the implementation in fact of the Integral Attention National Policy on Clinical Genetics.
INTRODUÇÃO: A deficiência intelectual (DI) ocorre em 2 a 3% da população e tem etiologia heterogênea (genética, ambiental ou multifatorial). O diagnóstico de DI requer uso de instrumentos validados, indisponíveis para crianças com idade inferior a 5 anos, para os quais reserva-se o termo atraso global do desenvolvimento (AGD). É imprescindível a avaliação especializada das pessoas com AGD/DI, isolado ou sindrômico, bem como a obtenção de um panorama detalhado dos fatores que possam se associar ao seu aparecimento. OBJETIVOS: Analisar os casos de AGD/DI em crianças e adolescentes que frequentaram a APAE São Luís descrevendo as características sociodemográficas, as condições da gestação, do parto, do recém-nascido, da evolução clínica e do acompanhamento. METODOLOGIA: Estudo quantitativo descritivo do tipo transversal. Foi realizada coleta de dados primários dos 156 pacientes atendidos no serviço de Genética Médica desta instituição em dezembro de 2009 a dezembro de 2010 e, utilizados Windows Excel Microsoft Office 2008 para tabulação e Epi Info 3.5.1 para cálculo de frequências simples. RESULTADOS: Foram observados: idade média de 36 meses, razão entre os sexos masculino e feminino de 1,2:1; deslocamento periódico para a capital, em 20% dos casos; consanguinidade parental de 4,5%; casos semelhantes na família em 7%. As mães: maioria entre 20 e 34anos, do lar, com pelo menos o Ensino Fundamental Completo e até duas gestações. Gestação: início do pré-natal até o terceiro mês em 63,5% (só 11% ainda no primeiro mês); 14% de exposição ao etanol, maioria nega exposição ao tabaco ou a fármacos impróprios; em 60%, houve intercorrências; em 17,3%, diagnósticos pré-natais de malformações ou infecções congênitas. Parto: 88,5% em hospital; 72% a termo e 21,8% pré-termos; via vaginal em 54,5% e cesárea em 35,3%; apresentação cefálica em 86%. Condições do recém-nato: 39% tem suspeita de hipóxia; 46,8% necessitaram de internação em UTI e, 44,5% estiveram internados por mais de oito dias. Anomalias do sistema nervoso central (SNC) foram encontradas em 61,5%, incluindo aquelas que puderam ser observadas pelas simples medida de perímetro cefálico - microcefalia (50%), macrocefalia (5%). A maioria não teve acesso aos exames complementares fundamentais à investigação diagnóstica (imagem de SNC, cariótipo, avaliação auditiva e oftalmológica). CONCLUSÕES: Reitera-se a carência de estudos sobre o tema; a iniquidade do acesso ao diagnóstico e ao tratamento; a necessidade de qualificação da assistência ao pré-natal e ao parto e, da implementação de fato da Política Nacional de Atenção Integral em Genética Clínica.

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Blair, Christopher Lington y Christopher Lington Blair. "Impact of Male Involvement on Antenatal Care Services Utilization in Malawi". Thesis, 2018. http://ndltd.ncl.edu.tw/handle/ebweb7.

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Chaibva, Cynthia Nombulelo. "Factors influencing adolescents' utilisation of antenatal care services in Bulawayo, Zimbabwe". Thesis, 2007. http://hdl.handle.net/10500/1975.

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Adolescent pregnancies are high risks obstetric occurrences. Antenatal care (ANC) provides opportunities to recognise and treat obstetric complications, enhancing the pregnancy outcomes for mothers and babies. This study investigated factors influencing pregnant adolescents' utilisation of ANC services in Bulawayo, using the Health Belief Model's major tenets. A quantitative descriptive design was used in four phases: 80 adolescents' ANC records were audited; structured interviews were conducted with 200 adolescents attending ANC and with 80 adolescents who had delivered their babies without attending ANC; and 52 midwives completed questionnaires portraying their perceptions on adolescents' utilisation of ANC services in Bulawayo. Documentation of ANC services provided to adolescents did not meet the expected standards. Poor or non utilisation of ANC services was influenced by socio demographic factors, individual perceptions of adolescents about antenatal care, perceived benefits of and perceived barriers to the utilisation of ANC. Most pregnant adolescents could not access these services because they could not pay the ANC and/or delivery fees charged at government clinics/hospitals. Midwives required more training in providing and recording adequate ANC services. Free ANC and delivery services could enhance adolescents' pregnancy outcomes in Zimbabawe. An information brochure on the importance of ANC attendance for adolescents has been compiled, based on the research results (see Annexure J).
Health Studies
D.Litt. et Phil. (Health Studies)

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Svensson, Jane L. "Antenatal education : meeting consumer needs. A study in health services development". 2005. http://hdl.handle.net/2100/948.

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This research situated antenatal education within a health promotion framework to determine a consumer-based approach to improving antenatal and postnatal education purported to prepare for parenthood. Research, both published and unpublished, criticises current structured educational programs and first time parents are reported to experience high levels of stress and unhappiness. Stage One of this study was a multiple source, multiple methods needs assessment conducted at two large, metropolitan hospitals in Sydney. The aim of the needs assessment was to explore the needs, interests and concerns of first time expectant and new parents, their changing nature during the childbearing year, ascertain learning processes that best suited their needs, and plan effective antenatal education around the results. Repeated in-depth interviews, focus groups, participant observation and surveys were used to collect data from expectant and new parents. Focus groups, surveys and participant observation were used to collect complementary data from educators, midwives and Child and Family Health Nurses who work with expectant and new parents. The third source of data analysed was documentary, that is program outlines and session plans of three comparable hospitals. The needs assessment demonstrated that to effectively prepare women and men for their childbearing experience, a range of strategies, programs and learning activities were required. This resulted in the design of a ‘menu’1 approach to antenatal and postnatal education with an emphasis placed on ‘life as a mum and a dad’, and the ‘world’ of their baby. The results also demonstrated a significant difference existed between the actual learning needs and priorities of expectant and new parents and those perceived to be their needs by the professionals. Expectant and new parents questioned the group facilitation skills of educators and identified methods to improve practice. Three strategies identified by these expectant and new parents as priorities were designed, implemented and an evaluation of each was undertaken in Stage Two of this study. The strategies were: 1. Seven session Having a Baby program for first time parents. 2. Group skills training program for antenatal and postnatal educators. 3. Breastfeeding resource package for antenatal educators. Stage Three of this research was an empirical study. A repeated measures randomised control trial was undertaken to test the effectiveness of the new Having a Baby program. In particular whether women and men who attended this program had improved perceived parenting self-efficacy, knowledge, and decreased worry about the baby eight weeks after birth compared with those who attended the conventional antenatal education program. The new program placed the labour and birth experience as a microcosm of the childbearing experience, and incorporated learning activities designed to enhance the confidence of pregnant women and their partners during their adjustment to parenthood. Perceived parenting self-efficacy2 was the measure by which parenting confidence, and therefore adjustment to parenthood, was measured The randomised control trial demonstrated that the perceived parenting self-efficacy of women and men in the experimental group was higher than those of control group participants at approximately eight weeks after the birth, with the difference being statically significant. The labour and birth outcomes of both groups, and their demographic details, were similar. Evaluation of the group skills training program for antenatal and postnatal educators and the breastfeeding resource package for antenatal educators were undertaken. Data collected from focus groups, interviews and surveys demonstrated the effectiveness of these strategies. The findings of this research question the validity of conventional antenatal classes and confirm the need for training and mentoring of antenatal educators. Effective, high quality antenatal education operating within budget allocation, facilitated by group skills trained educators, can produce superior postnatal outcomes.

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Mukhalela, Tatenda. "Utilisation of antenatal care services in rural primary health care facilities in Mutasa District, Zimbabwe". Diss., 2019. http://hdl.handle.net/11602/1446.

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MPH
Department of Public Health
The high maternal mortality ratio is caused by various factors, including avoidable complications which can be reduced by attendance to antenatal care visits. The utilisation of antenatal care has been low in rural areas, especially in Africa. The purpose of this study was to explore the utilisation of antenatal care in Mutasa District of Zimbabwe. This study used a qualitative study approach, adopting the descriptive, explorative design that presented an active image of the research participants’ reality and capture live experiences. Participants of the study were pregnant women and women with children under the age of one. The participant were sampled using purposive and snow-ball sampling techniques. In-depth interviews were conducted. The participants were interviewed in their native language, Shona. The main question was: Can you explain in your own words how you use antenatal care services from the primary health care facility? The researcher clarified questions which the participant failed to understand. The researcher wrote down all responses and used a tape recorder to capture the responses. The researcher analysed data using thematic content analysis where themes and sub-themes were discussed. The main theme was low uptake of antenatal care in rural primary health care facilities. From the main theme there were factors influencing and perceptions of women on uptake of antenatal care services in primary health care facilities. Trustworthiness was ensured through credibility, dependability, transferability and conformability. Permission from the relevant authorities, such as the University of Venda Higher Degrees Committee, the Provincial Medical Director and the District Administrator was sought before conducting this study. Informed consent was also sought before interviewing the participants. The study concluded that socio-demography of participants affected antenatal care attendance. These are age, level of education, low income, high parity and distance to facility. Other hindering factors to utilization of antenatal care were lack of knowledge, religion and acceptability of antenatal care by the women in rural primary health care facilities. Findings will be disseminated through a research report and published in relevant accredited journals with the help of the supervisors. The study recommended that the Ministry of Health and Child Care of Zimbabwe review Antenatal Care policies to ensure friendliness and to increase awareness through health education and continuous dissemination of antenatal care information.
NRF

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Iiyambo, Norbert. "Barriers to utilization of antenatal care services among pregnant women in Omaheke region, Namibia". Diss., 2017. http://hdl.handle.net/10500/24979.

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The purpose of the study is to determine the barriers to utilisation of antenatal care services among pregnant women in Omaheke Region - Namibia. A quantitative, cross-sectional descriptive research was followed, and a structured questionnaire was used to obtain information from study participants. One hundred and ten (110) women of child-bearing age between 18 to 49 years who visited Gobabis District Hospital in Omaheke Region for deliveries (full-term) or kept for postnatal care purposes were selected. A questionnaire with open-ended and closed-ended questions was designed using a Likert scale to gather information. SPSS software was used to generate descriptive statistics. Results indicated that the majority of respondents (39%) who attended antenatal care services, fell within the age range of 18-21 years. Participants demonstrated higher knowledge of the recommended number of antenatal care visits and of the importance of antenatal care services. Transport money and cost, long distances to health facilities, desirability, unplanned or unwanted pregnancy, and limited transportation options are the barriers that contribute to low utilisation of antenatal care services among pregnant women in Omaheke Region. Recommendations for deployment of more qualified midwives at rural antenatal clinics, building more antenatal care clinics in the region and creation of community awareness campaigns on the importance of antenatal care may increase the utilisation of antenatal care services in the Region. It is anticipated that this research will contribute to the promotion and utilisation of antenatal care services among pregnant women in Omaheke Region.
Health Studies
M. P. H.

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Tladi, Florah Maletsema. "Factors that influence the accessibility of antenatal care clinics in the Northern (Limpopo) Province". Thesis, 2008. http://hdl.handle.net/10210/1682.

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D.Cur
One of the most important factors relating to antenatal care provisions as One of the most important componentscomponents of P rimary Health Carecomponents of Prima ry Health C are (PHC ) is that the provisio forfor all pregnant women for whom these provisions afor all pregnant women for whom these provisions related to the a vailability, afforda bility, accepta bility, effectiveness, efficiency , equityrelated to the availability, utilization of the antenatal care clinics by pregnant women. TheThe White Paper on the Trans foThe White Paper on the Trans formation of The White Paper on services be madeservices be ma de accessib le for all the po pulation grou ps in South A frica. Thisservices thethe health services should be equally accessible in thethe health services should be equally accessible in WhiteWhite Paper states tha t all citizens shou ld have equ al access toWhite Paper states that all citizens should entitled. The right of access to health care means that: " Health professionals are obliged to facilitate access. The following constitute access to health care: " Functional services, of sufficient quality; " Physical, economic and information access; " Respect for ethics and culture, including language; " Scientifically appropriated and high quality care; and " Recognition of the needs of vulnerable groups. IfIf the curriculum for the training ofIf the curriculum for the training of primary health careIf the curriculum itit should reflect community needs more accura tely and the teaching sho uldit should reflect community moremore emphasis on community and oumore emphasis on community and outcome-bmore emphasis undertundertaundertakenundertaken to explore and describe the factors that influence the accessibility of carecare services in the then Central Region of the then Northern Prcare services in the then Central strategies to address such factors. TheThe aim of this study was to expThe aim of this study was to explore and desThe aim of this accessibilityaccessibility of antenatalaccessibility of antenatal care clinics in the rural areas. The researcher descrip tivedescriptive and contextualdescriptive and contextual design to approachdescriptive and contextual obtained th rough interview s withobtained through interviews with postpartum women, clinic and hospitalobtained withwith nurses fromwith nurses from thewith nurses from the Maternal and Child Health (MCH) Office in ofof Heaof Healof Health and Welfare. The second phase entailed the development of strategies addressingaddressing thoaddressing those factors addressing those factors that influence the accessibility data obtained in phase one of this study as well as from the literature. TheThe results of this research show that several personal anThe results of this research show that several byby both health care us ers and health care providersby both health c are users and h ealth care provid ers haveby thethe antenatal care clinics. The principal factors are: adolescent pregnancy,the antenatal care clinics. humanhuman and materialhuman and material resources, thehuman and material resources, the considerable thethe long waiting hours, paucity of community ithe long waiting hours, paucity of community involvemethe relatingrelating to the organization of health care activities at the clinic, andrelating to the organization of and safety at the clinics. RecommRecommendationsRecommendations evolving from this study are that the Health Department should moremore nurse s and mater ial resources, the clinicmore nurses and material resources, the clinic should be organised nnursesnurses shounurses should be given in-service education in primary health care (PHC), including antenatalantenatal care services, on a regular basis in order to equip themantenatal care services, on a clinics.clinics. Security of the clinic en vironment should be imp roved to ensu re the safety o f both personnel and patients on a twenty-four hourpersonnel and patients on a twenty-four hour basis. Antenatal more accessible to all the communities.

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