Abstract:
BACKGROUND:Reducing the maternal mortality ratio to less than 70 per 100,000 live births globally is one of the Sustainable Development Goals. Approximately 830 women die from pregnancy- or childbirth-related complications every day. Almost 99% of these deaths occur in developing countries. Increasing antenatal care quality and completion, and institutional delivery are key strategies to reduce maternal mortality, however there are many implementation challenges in rural and resource-limited settings. In Nepal, 43% of deliveries do not take place in an institution and 31% of women have insufficient antenatal care. Context-specific and evidence-based strategies are needed to improve antenatal care completion and institutional birth. We present an assessment of effectiveness outcomes for an adaptation of a group antenatal care model delivered by community health workers and midwives in close collaboration with government staff in rural Nepal. METHODS:The study was conducted in Achham, Nepal, via a public private partnership between the Nepali non-profit, Nyaya Health Nepal, and the Ministry of Health and Population, with financial and technical assistance from the American non-profit, Possible. We implemented group antenatal care as a prospective non-randomized, cluster-controlled, type I hybrid effectiveness-implementation study in six village clusters. The implementation approach allowed for iterative improvement in design by making changes to improve the quality of the intervention. We evaluated effectiveness through a difference in difference analysis of institutional birth rates between groups prior to implementation of the intervention and 1 year after implementation. Additionally, we assessed the change in knowledge of key danger signs and the acceptability of the group model compared with individual visits in a nested cohort of women receiving home visit care and home visit care plus group antenatal care. Using a directed content and thematic approach, we analyzed qualitative interviews to identify major themes related to implementation. RESULTS:At baseline, there were 457 recently-delivered women in the six village clusters receiving home visit care and 214 in the seven village clusters receiving home visit care plus group antenatal care. At endline, there were 336 and 201, respectively. The difference in difference analysis did not show a significant change in institutional birth rates nor antenatal care visit completion rates between the groups. There was, however, a significant increase in both institutional birth and antenatal care completion in each group from baseline to endline. We enrolled a nested cohort of 52 participants receiving home visit care and 62 participants receiving home visit care plus group antenatal care. There was high acceptability of the group antenatal care intervention and home visit care, with no significant differences between groups. A significantly higher percentage of women who participated in group antenatal care found their visits to be 'very enjoyable' (83.9% vs 59.6%, p = 0.0056). In the nested cohort, knowledge of key danger signs during pregnancy significantly improved from baseline to endline in the intervention clusters only (2 to 31%, p < 0.001), while knowledge of key danger signs related to labor and childbirth, the postpartum period, and the newborn did not in either intervention or control groups. Qualitative analysis revealed that women found that the groups provided an opportunity for learning and discussion, and the groups were a source of social support and empowerment. They also reported an improvement in services available at their village clinic. Providers noted the importance of the community health workers in identifying pregnant women in the community and linking them to the village clinics. Challenges in birth planning were brought up by both participants and providers. CONCLUSION:While there was no significant change in institutional birth and antenatal care completion at the population level between groups, there was an increase of these outcomes in both groups. This may be secondary to the primary importance of community health worker involvement in both of these groups. Knowledge of key pregnancy danger signs was significantly improved in the home visit plus group antenatal care cohort compared with the home visit care only group. This initial study of Nyaya Health Nepal's adapted group care model demonstrates the potential for impacting women's antenatal care experience and should be studied over a longer period as an intervention embedded within a community health worker program. TRIAL REGISTRATION:ClinicalTrials.gov Identifier: NCT02330887 , registered 01/05/2015, retroactively registered.
journal_name
Reprod Healthjournal_title
Reproductive healthauthors
Thapa P,Bangura AH,Nirola I,Citrin D,Belbase B,Bogati B,Nirmala BK,Khadka S,Kunwar L,Halliday S,Choudhury N,Ozonoff A,Tenpa J,Schwarz R,Adhikari M,Kalaunee SP,Rising S,Maru D,Maru Sdoi
10.1186/s12978-019-0820-8subject
Has Abstractpub_date
2019-10-22 00:00:00pages
150issue
1issn
1742-4755pii
10.1186/s12978-019-0820-8journal_volume
16pub_type
杂志文章abstract:BACKGROUND:Ultrasound during antenatal care (ANC) is proposed as a strategy for increasing hospital deliveries for complicated pregnancies and improving maternal, fetal, and neonatal outcomes. The First Look study was a cluster-randomized trial conducted in the Democratic Republic of Congo, Guatemala, Kenya, Pakistan a...
journal_title:Reproductive health
pub_type: 杂志文章
doi:10.1186/s12978-018-0647-8
更新日期:2018-12-12 00:00:00
abstract:BACKGROUND:Disrespectful and abusive treatment during childbirth is a violation of women's right to dignified, respectful healthcare throughout pregnancy and childbirth. Although reports point out that marginalized groups in society such as single mothers are particularly vulnerable to abusive and disrespectful care, t...
journal_title:Reproductive health
pub_type: 杂志文章
doi:10.1186/s12978-017-0290-9
更新日期:2017-03-04 00:00:00
abstract:BACKGROUND:Maternal mortality in South Africa is high and a cause for concern especially because the bulk of deaths from maternal causes are preventable. One of the proposed reasons for persistently high maternal mortality is HIV which causes death both indirectly and directly. While there is some evidence for the impa...
journal_title:Reproductive health
pub_type: 杂志文章
doi:10.1186/1742-4755-12-S1-S5
更新日期:2015-05-06 00:00:00
abstract::The ICPD agenda of reproductive health was declared as the most comprehensive one, which had actually broadened the spectrum of reproductive health and drove the states to embark upon initiatives to improve reproductive health status of their populations. However, like all other countries, Pakistan also seems to have ...
journal_title:Reproductive health
pub_type: 杂志文章
doi:10.1186/1742-4755-5-4
更新日期:2008-09-10 00:00:00
abstract:BACKGROUND:Despite improved health facility access relative to rural areas, distance and transportation remain barriers in some urban areas. Using household and facility data linked to residential and transportation geographic information we describe availability of health facilities offering long-acting reversible con...
journal_title:Reproductive health
pub_type: 杂志文章
doi:10.1186/s12978-019-0828-0
更新日期:2019-11-08 00:00:00
abstract:BACKGROUND:Men in northern Nigeria are considered the leaders and ultimate decision makers, including decisions about health-related behaviours of their wives and children. Yet many men in the region consider pregnancy and childbirth to be in the woman's domain (even if she cannot make related decisions), and may not s...
journal_title:Reproductive health
pub_type: 杂志文章
doi:10.1186/s12978-019-0761-2
更新日期:2019-07-15 00:00:00
abstract:BACKGROUND:Greater paternal engagement is positively associated with improved access to and utilization of maternal services. Despite evidence that male involvement increased uptake of maternal and child services, studies show that few men are participating in MNCH programs. Community leaders have long been engaged in ...
journal_title:Reproductive health
pub_type: 杂志文章
doi:10.1186/s12978-019-0752-3
更新日期:2019-06-21 00:00:00
abstract:BACKGROUND:Most women report negative experience about the symptoms of uterine leiomyoma (UL) in their lives, such as abnormal uterine bleeding and pelvic pain. Many studies have been conducted about efficacy of UL treatment, but little research has been performed about womens health related quality of life (HRQL). ME...
journal_title:Reproductive health
pub_type: 杂志文章
doi:10.1186/1742-4755-11-10
更新日期:2014-01-30 00:00:00
abstract::Over the last 30 years, conservative power in the United States, financed and organized by Christian fundamentalist sects, the Catholic Church, and conservative corporate and political leadership, has become more threatening and potentially destabilizing of progressive democratic principles and practices. Powerful int...
journal_title:Reproductive health
pub_type: 杂志文章
doi:10.1186/1742-4755-8-1
更新日期:2011-01-05 00:00:00
abstract:BACKGROUND:Utilization of reproductive health services is an important component in preventing adolescents from different sexual and reproductive health problems. As a result, the extent of their service utilization should be determined before implementing any kind of interventions. Therefore, this study was aimed at a...
journal_title:Reproductive health
pub_type: 杂志文章
doi:10.1186/s12978-018-0659-4
更新日期:2018-12-27 00:00:00
abstract:BACKGROUND:It is well-established that couples' fecundities vary widely. Each couple has a relatively constant monthly probability of conceiving, which can vary from zero to quite high. This underlying probability is usually expressed as the time (number of menstrual cycles) the couple requires to conceive. Couples wit...
journal_title:Reproductive health
pub_type: 杂志文章
doi:10.1186/s12978-019-0754-1
更新日期:2019-06-24 00:00:00
abstract:BACKGROUND:Many patients use websites, blogs, or online social communities to gain health knowledge, information about disease symptoms, and disease diagnosis opinions. The purpose of this study is to use the online platform of blogs to explore whether the framing effect of information content, situated learning of inf...
journal_title:Reproductive health
pub_type: 杂志文章
doi:10.1186/1742-4755-11-93
更新日期:2014-12-26 00:00:00
abstract:BACKGROUND:To find out about the prenatal diagnosis rate of myelomeningocele (MMC) by ultrasound scan in patients referred to the Children's Hospital Medical Center in Tehran, Iran from July 2004 to July 2005. METHODS:We included 140 children born with MMC and who were referred for management, surgery and treatment of...
journal_title:Reproductive health
pub_type: 杂志文章
doi:10.1186/1742-4755-3-6
更新日期:2006-07-18 00:00:00
abstract:BACKGROUND:The aim of this study was to elucidate recurrent pregnancy loss (RPL)-associated psychosocial effects and sexual functions of Chinese men whose partners experience a history of RPL. METHODS:Questionnaire data from a total of 236 men whose partners experience RPL(RPL group) and another 236 non-RPL male volun...
journal_title:Reproductive health
pub_type: 杂志文章
doi:10.1186/s12978-016-0188-y
更新日期:2016-06-13 00:00:00
abstract:BACKGROUND:Mother-to-child transmission of HIV (MTCT) accounts for over 95% of all paediatric HIV infections worldwide. Several studies have shown that male participation in the antenatal care of their spouses together with couple counselling and testing for HIV, increases use of the interventions for HIV prevention. T...
journal_title:Reproductive health
pub_type: 杂志文章
doi:10.1186/1742-4755-7-12
更新日期:2010-06-23 00:00:00
abstract:BACKGROUND:In Tanzania, the provision of humanized care is increasingly being emphasized in midwifery practice, yet studies regarding perceptions and practices of skilled health personnel towards the humanization of birth care are scare. Previous reviews have identified that abuse and disrespect is not limited to indiv...
journal_title:Reproductive health
pub_type: 杂志文章
doi:10.1186/s12978-018-0583-7
更新日期:2018-08-14 00:00:00
abstract::As most pregnancy-related deaths and morbidities are clustered around the time of childbirth, quality of care during this period is critical to the survival of pregnant women and their babies. Despite the wide acceptance of partograph as the central tool to optimize labour outcomes for over 40 years, its use has not s...
journal_title:Reproductive health
pub_type: 杂志文章
doi:10.1186/s12978-015-0027-6
更新日期:2015-05-26 00:00:00
abstract::Abortion is legally restricted in most of Latin America where 95% of the 4.4 million abortions performed annually are unsafe. Medical abortion (MA) refers to the use of a drug or a combination of drugs to terminate pregnancy. Mifepristone followed by misoprostol is the most effective and recommended regime. In setting...
journal_title:Reproductive health
pub_type: 杂志文章,评审
doi:10.1186/1742-4755-9-34
更新日期:2012-12-22 00:00:00
abstract:BACKGROUND:In Bangladesh, abortion is restricted except to save the life of a woman, but menstrual regulation is allowed to induce menstruation and return to non-pregnancy after a missed period. MR services are typically provided through the Directorate General of Family Planning, while postabortion care services for i...
journal_title:Reproductive health
pub_type: 杂志文章
doi:10.1186/s12978-017-0298-1
更新日期:2017-03-11 00:00:00
abstract:BACKGROUND:We thank Bijlmakers et al. for their interest in our article, "A never-before opportunity to strengthen investment and action on adolescent contraception, and what we must do to make full use of it", and are grateful for the opportunity to respond to their four key assertions. RESPONSE:First, we fully agree...
journal_title:Reproductive health
pub_type: 社论
doi:10.1186/s12978-018-0457-z
更新日期:2018-01-30 00:00:00
abstract:BACKGROUND:Although abortion is legally available in South Africa, barriers to access exist. Early medical abortion is available to women with a gestational age up to 63 days and timely access is essential. This study aimed to determine women's acceptability and ability to self-assess eligibility for early medical abor...
journal_title:Reproductive health
pub_type: 杂志文章,多中心研究
doi:10.1186/s12978-016-0160-x
更新日期:2016-04-16 00:00:00
abstract:BACKGROUND:Postpartum haemorrhage (PPH) is the leading cause of maternal mortality in low-income countries and is a significant contributor to severe maternal morbidity and long-term disability. Carbetocin may be an underused uterotonic for prevention of PPH. A number of studies are being conducted that may challenge t...
journal_title:Reproductive health
pub_type: 杂志文章,评审
doi:10.1186/s12978-018-0529-0
更新日期:2018-06-22 00:00:00
abstract:BACKGROUND:A cultural preference for sons has been well documented in India, resulting in skewed sex ratios, especially exhibited in northwest India. Previous research has shown that family sex composition is associated with family planning (FP) use and couples' desire for more children. This study examines family sex ...
journal_title:Reproductive health
pub_type: 杂志文章
doi:10.1186/1742-4755-10-48
更新日期:2013-09-11 00:00:00
abstract:BACKGROUND:Patients with multiple sclerosis (MS) especially those with younger age experience an alteration in physiological and emotional lifestyle that can affect intimacy and sexuality. The aim of this study was to determine demographic and disease related determinants of intimacy and sexuality in young women with M...
journal_title:Reproductive health
pub_type: 杂志文章
doi:10.1186/s12978-020-00960-5
更新日期:2020-07-10 00:00:00
abstract:BACKGROUND:Malaria infection in pregnancy is a major risk factor for maternal and child death, and substantially increases the risk of miscarriage, stillbirth and low birthweight. The aim of this study therefore is to assess the prevalence and determinants of Intermittent preventive treatment of Malaria [IPTp] utilizat...
journal_title:Reproductive health
pub_type: 杂志文章
doi:10.1186/1742-4755-9-12
更新日期:2012-08-13 00:00:00
abstract:BACKGROUND:South Sudan has one of the worst health and maternal health situations in the world. Across South Sudan, while maternal health services at the primary care level are not well developed, even where they exist, many women do not use them. Developing location specific understanding of what hinders women from us...
journal_title:Reproductive health
pub_type: 杂志文章
doi:10.1186/s12978-018-0487-6
更新日期:2018-03-20 00:00:00
abstract:BACKGROUND:Stringent donor-screening criteria and legislation prohibiting payment for donor gametes have contributed to the radical decline of donor insemination (DI) using sperm provided by Canadian men. Thus, many individuals rely on imported sperm. This paper examines the feasibility of an altruistic sperm donation ...
journal_title:Reproductive health
pub_type: 杂志文章
doi:10.1186/s12978-016-0275-0
更新日期:2017-01-14 00:00:00
abstract:BACKGROUND:In Senegal, unintended pregnancy has become a growing concern in public health circles. It has often been described through the press as a sensational subject with emphasis on the multiple infanticide cases as a main consequence, especially among young unmarried girls. Less scientific evidence is known on th...
journal_title:Reproductive health
pub_type: 杂志文章
doi:10.1186/1742-4755-10-59
更新日期:2013-11-19 00:00:00
abstract:BACKGROUND:Globally, postpartum haemorrhage (PPH) remains a leading cause of maternal deaths. However in many low and middle income countries, there is scarcity of information on magnitude of and risk factors for PPH (blood loss of 500 ml or more). It is important to understand the relative contributions of different r...
journal_title:Reproductive health
pub_type: 杂志文章,多中心研究
doi:10.1186/s12978-016-0154-8
更新日期:2016-04-14 00:00:00
abstract:BACKGROUND:Worldwide, about 50% of all new cases of HIV occur in youth between age 15 and 24 years. Studies in various sub-Saharan African countries show that both out of school and in school adolescents and youth are engaged in risky sexual behaviors. School-based health education has been a cornerstone of youth-focus...
journal_title:Reproductive health
pub_type: 杂志文章
doi:10.1186/s12978-015-0077-9
更新日期:2015-09-07 00:00:00