Background Timely initiation of antenatal care can avoid pregnancy related problems and save lives of mothers and babies. In developing nations, however, only half of the pregnant mothers receive the recommended number of antenatal care visits, and start late in their pregnancy. Thus, the study was conducted to assess the magnitude of timely initiation of antenatal care and factors associated with the timing of antenatal care attendance in Axum in which studies regarding this issue are lacking. Methods An institution based cross-sectional study mixed with qualitative approach was conducted. A total of 386 pregnant women were selected using systematic sampling technique for the quantitative study. In addition, 18 participants were selected purposively for the qualitative part. The quantitative data were collected using structured interviewer administered questionnaire while the qualitative data were collected using an open-ended interview guide. Quantitative data were analyzed using SPSS version 22 and the qualitative data were analyzed using Atlas software. Multi-variable logistic regression was used to control the effect of confounders. Results The magnitude of timely attendance of antenatal care was 27.5% (95% CI: 23–32%). Unintended pregnancy (AOR = 2.87; CI 95%: 1.23–6.70), maternal knowledge (AOR = 2.75; CI 95%: 1.07–7.03), educational status of the women (AOR = 2.62; CI 95%: 1.21–5.64), perceived timing of antenatal care (AOR = 3.45; CI 95%: 1.61–7.36), problem in current pregnancy (AOR = 3.56; CI 95%: 1.52–8.48) and advice from significant others (AOR =2.33; CI 95%: 1.10–4.94) were found significantly associated with timely booking of antenatal care. Conclusion The magnitude of timely attendance of antenatal care is low. Educational status, maternal knowledge, unintended pregnancy, problem in current pregnancy, perceived timing of antenatal care, and advise from significant others were the significant factors for timing of antenatal care. Therefore more effort should be done to increase the knowledge of mothers about importance of antenatal care and timely ante natal care booking.

Background Most of the maternal and newborn deaths occur at birth or within 24 h of birth. Provision of quality Basic Emergency Obstetric and Neonatal Care (BEmONC) is very crucial and the current recommended intervention to prevent maternal and newborn morbidity and mortality. Methods An institution based cross-sectional study was conducted among mothers receiving at least one of the signal functions of BEmONC services. A total of 398 women were included in the study. The study participants were selected using a systematic random sampling method. Data was collected using structured interviewer-administered Tigrigna version questionnaire. Data were analyzed using SPSS version 20. Multi-variable logistic regression was used to control the effect of confounders. Results The perceived quality of BEmONC was 66.7%, which is poor. Clients scored lower quality rates on aspects such as the availability of necessary equipment, lack of clean and functional shower and toilet and administration of anti-pain during delivery and manual vacuum aspiration (MVA). Quality of BEmONC was lower among rural residents (AOR = 0.273, 95% CI: (0.151–0.830). Whereas, Presence of companion (AOR = 2.259; 95% CI: (3.563–13.452) were found with a higher score of quality of BEmONC compared to their counterparts. Conclusion The overall perception of quality of BEmONC services received was poor. Residence, ANC follow-up, and presence of companion during labor or delivery were found to have a significant association with the perceived quality of BEmONC services. Electronic supplementary material The online version of this article (10.1186/s12884-019-2307-6) contains supplementary material, which is available to authorized users.

groups which cause pain. Though widely used in peri-operative settings, RA has been slow to gain traction in the ED. Here, we developed a low-cost, low-fidelity, simulation-based training curriculum in ultrasound-guided RA for emergency physicians. We predict this training will improve physician competence and confidence in performing and supervising RA, and will result in higher use of RA in the ED overall.Methods: Emergency physicians (EPs: attendings and residents) from a large, urban, tertiary-care hospital were prospectively enrolled to participate in a 2-hour inperson training session. Training sessions began with a brief didactic on RA indications, contraindications, and safety. Following the didactic session, EPs were divided into 3-5 person groups and rotated through 4 learning stations each equipped to teach one nerve block which can be used for a common ED indication: femoral nerve block for femoral neck fractures, transgluteal sciatic nerve block for sciatica, serratus anterior plane block for rib fractures, and interscalene block for proximal humerus fractures. At each station learners participated in ultrasound scanning on live models to identify relevant sonographic landmarks (nerves, muscles, and facial planes), and hands-on practice for mastering ultrasound-guided needle control, hydrodissection, and anesthetic injection in reusable pork models. Pork models were hand-built from household goods and were created to mimic the anatomy of each of the 4 featured nerve blocks. Learner confidence and competence with performing and supervising RA was assessed pre-and post-training session via electronic surveys.Results: In total, 23 participants enrolled in initial training sessions. Of these, 57% were male, 26% were faculty, and 74% were residents from all years of training. After the training session, learners reported a 30% increase in provider confidence in performing RA (p ¼ 0.0005), and a 36% increase in provider confidence in supervising RA being performed by a trainee (p ¼ 0.0092) compared to pre-training session. Provider knowledge of RA techniques and concepts increased 18% from pre-to posttraining session (p ¼ 0.0010). Reusable pork models cost approximately $12 each to produce.Conclusions: A low-cost, low-fidelity simulation curriculum can improve provider competence and confidence in both performing and supervising ultrasound-guided RA in the short term. Next steps to assess the quality of this educational intervention include reassessing learners competence and confidence at 3-, and 6-months post-training via repeat surveys, comparing the frequency of ultrasound-guided RA performance pre-and post-intervention in our cohort, and reviewing saved clips of ultrasound-guided RA performed by our cohort for quality assurance.