Preconception Care in Low- and Middle-Income Countries: New Opportunities and a New Metric

Young, Cheryl T.; Urquia, Marcelo L.; Ray, Joel G.

doi:10.1371/journal.pmed.1001507

Cited by 6 publications

(5 citation statements)

References 9 publications

(12 reference statements)

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“…Participants believed that this strategy would remove barriers associated with the out-of-pocket payment for health services. Similar findings were reported by Lassi et al ( 46 ) and Young et al ( 50 ) in their reviews of opportunities for delivery and packaging PCH interventions for reproductive-aged individuals. The findings are consistent with evidence that policy and finance are the most critical barriers to access and health system changes ( 52 ).…”

Section: Discussionsupporting

confidence: 87%

“…Mitchell and Verbiest reported consumer education, clinical care, advocacy and policy, research, and public health and community interventions as appropriate PCH delivery strategies ( 20 ). Research also shows that PCH interventions can be successfully delivered to reproductive-aged individuals in academic institutions ( 17 , 21 - 23 ).…”

Section: Introductionmentioning

confidence: 99%

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Integrating Preconception Health into Routine Reproductive Health Services of Ghana: A Qualitative Study Among University Students

Doe¹,

Hormenu²,

Enyan³

2022

JFRH

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Objective: The preconception health (PCH) strategy provides a unique opportunity to reduce risk factors for adverse reproductive outcomes before pregnancy. However, many reproductive-aged individuals continue to miss opportunities to improve their health before pregnancy occurs. This study, qualitatively explored strategies required for integrating PCH promotion interventions into routine reproductive health services from university students’ perspectives. Materials and methods: We conducted eight mixed-gender focus group discussions (FGDs) with students in eight schools and faculties in the University from March 2019 to June 2019. Audio-taped data were transcribed verbatim and analyzed manually using inductive content analysis. Results: Three major themes emerged from the analysis of transcripts: interpersonal behavior change strategies, institutional policy directives, public policy interventions, and three main categories with eight sub-categories. The study showed that PCH promotion awareness campaigns, context-relevant service delivery initiatives, institutional and public policy directives are critical approaches for the delivery and uptake of PCH interventions. Participants also recommended prepayment schemes, walk-in services, mobile PCH clinics, and PCH incorporation into university curricula as context-specific strategies for PCH promotion among university students. Conclusion: PCH promotion could be feasible as an integral component of routine reproductive health services for university students. However, multi-level interventions at the student, health service, and institutional levels are necessary to increase awareness and facilitate the request and delivery of PCH services.

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Section: Discussionsupporting

confidence: 87%

Section: Introductionmentioning

confidence: 99%

Integrating Preconception Health into Routine Reproductive Health Services of Ghana: A Qualitative Study Among University Students

Doe¹,

Hormenu²,

Enyan³

2022

JFRH

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“…While the PCC is one of Healthy People 2020's major strategic objectives, it has not been extensively understood and practiced, especially in low-income countries, including Ethiopia [6,35,36]. In contrast with other Continuum of Care (COC) maternal and child health services, the PCC can be viewed as the missing continuum elements [37].…”

Section: Plain Language Summarymentioning

confidence: 99%

Determinants of practice of preconception care among women of reproductive age group in southern Ethiopia, 2020: content analysis

Habte¹,

Dessu

Haile

2021

Reprod Health

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Background Preconception care (PCC) is a series of biomedical, mental, and psycho-social health services provided to women and a couple before pregnancy and throughout subsequent pregnancies for desired outcomes. Millions of women and new-borns have died in low-income countries due to impediments that arise before and exaggerate during pregnancies that are not deal with as part of pre-conception care. To the best of our knowledge, however, there is a lack of information about preconception care practice and its determinants in southern Ethiopia, including the study area. This study was therefore planned to assess the practice of preconception care and its determinants among mothers who recently gave birth in Wolkite town, southern Ethiopia, in 2020. Methods A community-based cross-sectional study was conducted from February 1 to 30, 2020. A total of 600 mothers who have given birth in the last 12 months have been randomly selected. A two-stage sampling technique was employed. For data collection, a pre-tested, semi-structured questionnaire was used. The data was encoded and entered into Epi-Data version 3.1 and exported for analysis to SPSS version 23. Household wealth status was determined through the application of principal component analysis(PCA). The practice PCC was considered as a count variable and measured as a minimum score of 0 and a maximum of 10. A bivariable statistical analysis was performed through analysis of variance (ANOVA) and independent t-tests and variables with a p-value of < 0.05 were eligible for the generalized linear regression model. To see the weight of each explanatory variable on PCC utilization, generalized linear regression with a Poisson link was done. Results Of the sampled 600 participants, 591 took part in the study, which yielded a response rate of 98.8%.The mean (± SD) score of the practice of PCC was 3.94 (± 1.98) with minimum and maximum scores of 0 and 10 respectively. Only 6.4% (95%CI: 4.6, 8.6) of mothers received all selected items of PCC services. Thecommonest item received by 67.2% of mothers was Folic acid supplementation, while 16.1% of mothers received the least item of optimizing psychological health. Education status of mother[AOR 0.74, 95%CI 0.63, 0.97], time spent to access nearby health facilities [AOR 0.69, 95%CI 0.58, 0.83], availability of PCC unit [AOR 1.46; 95%CI 1.17, 1.67], mother’s knowledge on PCC [AOR 1.34, 95%CI 1.13, 1.65], being a model household [AOR 1.31, 95%CI 1.18, 1.52] and women’s autonomy in decision making [AOR 0.75, 95%CI 0.64, 0.96] were identified as significant predictors of practice of PCC. Conclusion The uptake of WHO-recommended PCC service elements in the current study area was found to be unsatisfactory. Stakeholders must therefore increase their efforts to align PCC units with existing MNCH service delivery points, improve women's decision-making autonomy, and focus on behavioral change communication to strengthen PCC practice. Plain language summary Preconception care (PCC) is a series of biomedical, mental, and psycho-social health services provided to women and a couple before pregnancy and throughout subsequent pregnancies for better endings. The main goal of the PCC is to improve maternal and child health outcomes, by-promoting wellness and providing preventive care. It can also be seen as an earlier chance for teenage girls, mothers, and children to live a better and longer-term healthy life. Pieces of PCC service packages suggested by the World Health Organization(WHO) are, micronutrient supplementation (Folate supplementation), infectious disease (STI/HIV) screening and testing, chronic disease screening and management, healthy diet therapy, vaccination, prevention of substance use (cessation of cigarette smoking and too much alcohol consumption), optimizing psychological health, counseling on the importance of exercise and reproductive health planning and implementation. Millions of women and new-borns have died in low-income countries due to impediments that arise before and exaggerate during pregnancies that are not deal with as part of pre-conception care. To the best of our knowledge, however, there is a lack of information about preconception care practice and its determinants in southern Ethiopia, including the study area. This study was therefore planned to evaluate the practice of preconception care and its determinants among mothers who recently gave birth in Wolkite town, southern Ethiopia, in 2020. Mothers who have given birth in the last 12 months have been randomly selected Household wealth status was determined through the application of principal component analysis(PCA). To see the weight of each explanatory variable on PCC, generalized linear regression with a Poisson type was done. Accordingly, the Education status of the mother, time spent to access nearby health facilities, availability of PCC unit, mother’s knowledge on PCC, being a model household, and women’s autonomy in decision making were identified as significant predictors of practice of PCC. Stakeholders must therefore increase their efforts to align PCC units with existing MNCH service delivery points, improve women's decision-making autonomy, and focus on behavioral change communication to strengthen PCC practice.

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“…The SDG report 2014 indicates that since 1990 to 2015 maternal mortalities has reduced by only 50% and the proportion of mothers who do not survive childbirth compared to those who survive childbirth in the developing regions is 14 times higher than in developed nations [14]. A negative outcome of an expectant mother directly affects the fetus or the newborn [15]. So preconception care has found a place in the continuum of care aimed at improving maternal, newborn and child health in low and middle-income countries [16].…”

Section: Introductionmentioning

confidence: 99%

Utilization of preconception care and associated factors among reproductive age group women in Debre Birhan town, North Shewa, Ethiopia

et al. 2019

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Background Preconception care refers to things women can do before and between pregnancies to increase the chance of having a healthy baby and being a healthy mother. Unfortunately, millions of women in the world do not have access to pre-pregnancy, pregnancy health services and childbirth with suitable quality. Therefore, addressing this significant gap and coming up with the necessary information is helpful to improve maternal and child health in our country. So, this study was aimed to assess the utilization of preconception care and associated factors among reproductive age group women in Debre Birhan Town, North Shewa, Ethiopia. Methods A mixed method of community based cross-sectional study was employed from March 1st to 30; 2017. Systematic sampling technique was used to select a total of 424 reproductive age women. The data were collected using pre-tested and structured questionnaire and eight in-depth interviews were done using an interview guide. The collected data were coded and entered into Epi data 3.5.1 and exported to SPSS version 21 for cleaning and analysis. Logistic regression was run to look for the association between dependent and explanatory variables; and using variables which have p -value ≤0.25 binary logistic regression was fitted. Association presented in Odds ratio with 95% confidence interval and significance determined at P -value less than 0.05. Result A total of 410 subjects were participated with a response rate of 96.7%. The overall utilization of Preconception care was 13.4%. Woman’s age, marital status, knowledge and availability of unit for preconception care were significantly associated with utilization of preconception care with (AOR: 3.567; 95% CI: 1.082, 11.758), (AOR: 0.062; 95% CI: 0.007, 0.585), (AOR = 6.263; 95% CI: 2.855, 13.739) and AOR: 13.938; 95% CI: 3.516, 55.251) respectively. Conclusions The finding of this study showed that women’s utilization of preconception care is relatively low. A woman’s age, marital status, educational status, knowledge about preconception care services and availability of unit for preconception care were factors affecting utilization of preconception care. Therefore, establishing preconception care strategies which can address all the components of the care will be essential when designing effective implementation strategies for improving the uptake of preconception care.

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Preconception Care in Low- and Middle-Income Countries: New Opportunities and a New Metric

Abstract: Joel Ray and colleagues discuss the challenges and opportunities for improving pre-conception care for women in developing countries. Please see later in the article for the Editors' Summary

Cited by 6 publications

References 9 publications

Integrating Preconception Health into Routine Reproductive Health Services of Ghana: A Qualitative Study Among University Students

Integrating Preconception Health into Routine Reproductive Health Services of Ghana: A Qualitative Study Among University Students

Determinants of practice of preconception care among women of reproductive age group in southern Ethiopia, 2020: content analysis

Utilization of preconception care and associated factors among reproductive age group women in Debre Birhan town, North Shewa, Ethiopia

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