Antenatal care quality and detection of risk among pregnant women: An observational study in Ethiopia, India, Kenya, and South Africa

Background Antenatal care (ANC) is an essential platform to improve maternal and newborn health (MNH). While several articles have described the content of ANC in low- and middle-income countries (LMICs), few have investigated the quality of detection and management of pregnancy risk factors during ANC. It remains unclear whether women with pregnancy risk factors receive targeted management and additional ANC. Methods and findings This observational study uses baseline data from the MNH eCohort study conducted in 8 sites in Ethiopia, India, Kenya, and South Africa from April 2023 to January 2024. A total of 4,068 pregnant women seeking ANC for the first time in their pregnancy were surveyed. We built country-specific ANC completeness indices that measured provision of 16 to 22 recommended clinical actions in 5 domains: physical examinations, diagnostic tests, history taking and screening, counselling, and treatment and prevention. We investigated whether women with pregnancy risks tended to receive higher quality care and we assessed the quality of detection and management of 7 concurrent illnesses and pregnancy risk factors (anemia, undernutrition, obesity, chronic illnesses, depression, prior obstetric complications, and danger signs). ANC completeness ranged from 43% in Ethiopia, 66% in Kenya, 73% in India, and 76% in South Africa, with large gaps in history taking, screening, and counselling. Most women in Ethiopia, Kenya, and South Africa initiated ANC in second or third trimesters. We used country-specific multivariable mixed-effects linear regression models to investigate factors associated with ANC completeness. Models included individual demographics, health status, presence of risk factors, health facility characteristics, and fixed effects for the study site. We found that some facility characteristics (staffing, patient volume, structural readiness) were associated with variation in ANC completeness. In contrast, pregnancy risk factors were only associated with a 1.7 percentage points increase in ANC completeness (95% confidence interval 0.3, 3.0, p-value 0.014) in Kenya only. Poor self-reported health was associated with higher ANC completeness in India and South Africa and with lower ANC completeness in Ethiopia. Some concurrent illnesses and risk factors were overlooked during the ANC visit. Between 0% and 6% of undernourished women were prescribed food supplementation and only 1% to 3% of women with depression were referred to a mental health provider or prescribed antidepressants. Only 36% to 73% of women who had previously experienced an obstetric complication (a miscarriage, preterm birth, stillbirth, or newborn death) discussed their obstetric history with the provider during the first ANC visit. Although we aimed to validate self-reported information on health status and content of care with data from health cards, our findings may be affected by recall or other information biases. Conclusions In this study, we observed gaps in adherence to ANC standards, particularly for women in need of specialized management. Strategies to maximize the potential health benefits of ANC should target women at risk of poor pregnancy outcomes and improve early initiation of ANC in the first trimester

Konzeption und Realisierung einer Datenbankmigration zwischen relationalen und dokumentenorientierten Datenbanksystemen

Mit der Entstehung und Verbreitung der NoSQL Datenbanken, sind Datenbankkonzepte mit speziellen Kernkompetenzen etabliert worden. Diese bieten für bestimmte Anwendungsfälle eine angepasste Lösung, welche eine relationale Datenbank nicht effizient behandeln kann. Damit einher geht das Problem zwischen zwei andersartigen Datenbankmodellen zu migrieren. Nicht nur die Daten benötigen in einer NoSQL Datenbanken eine andere Struktur, sondern auch die verwendeten Funktionalitäten können variieren. Die Masterthesis analysiert zu dieser Problematik bereits vorhandene Konzepte zur Migration von relationalen zu dokumentenorientierten Datenbanken. Basierend darauf wird ein eigenes Konzept zur Migration und der damit einhergehenden Umwandlung der Struktur, entwickelt. Ebenfalls ausgewertet werden die Funktionalitäten anhand von konkreten Beispieldatenbanken. Diese Analyse und Auswertung bezieht sich nicht nur auf die Migration von relationalen zu dokumentenorientierten Datenbanken, sondern ebenfalls auf die Migration zwischen dokumentenorientierten. Um abschließend das Konzept auszuwerten wird ein Tool, die Rel(Dok)2 entwickelt, welche mittels Beispieldatensätzen exemplarisch die korrekte Funktion des Tools und damit die des Konzeptes evaluiert.With the emergence and distribution of NoSQL databases, database concepts with special core competences have been established. These offer for certain use cases adapted solutions, which a relational database can not handle efficiently. This is accompanied by the problem to migrate between two different database models. Not only the data needs a different structure in a NoSQL database, even the used functionalities can vary. The master thesis analyses to the complex of problems existing concepts for the migration from relational to document-oriented databases. Based on this, an own concept for the migration and the accompanied transformation of the structure will be developed. As well evaluated are the the functionalities on the basis of concrete example databases. This analysis and evaluation not only refers to the migration from relational to documentoriented databases, but also to the migration between document-oriented databases. To finally evaluate the concept, a tool, Rel(Dok)2, will be developed, which evaluates with example data sets the correct function of the tool and thus of the concept

Do labor market regulations affect the link between innovation and employment? Evidence from Latin America

The link between innovation and employment is at the center of the policy debate. This paper sheds light on how labor market regulations affect the relationship between different types of innovation and employment in Latin America. We estimate the model developed by Harrison et al. (2014) using Enterprise Surveys for 14 Latin American countries. We find that: (i) product innovations have a positive impact on employment growth; (ii) process innovations do not affect employment growth; (iii) more rigid labor market regulations (minimum wages and severance payments) reduce the effects of innovation

Intra-household gender dynamics and the adoption of best practices among teff farmers in Ethiopia

Teff farming in Ethiopia is commonly seen as being dominated by men, with women playing supporting roles on some aspects of the growing process. This study is rooted in existing literature on drivers of Best Practices (BP) adoption and decision-making theory and is unique in that it focuses primarily on understanding how gender-specific factors influence decision-making on the adoption of BPs. To this end, the study assessed the intra-household gender dynamics at play within farming households in Amhara, Ethiopia, and their influence on deciding whether or not to adopt agricultural best practices for teff farming. These gender dynamics include the division of labor between women and men, intra-household decisionmaking processes, social and cultural norms and access factors (such as access to information, training, credit and control over income). Using data from a threeround quantitative survey with one woman and one man in 555 households, as well as focus group discussions and in-depth interviews, this study is uniquely placed to assess the impact of these gender-specific and intra-household factors on the adoption of best practices. The findings show that households where women are more involved in teff farming, have less input into decision-making, less control over income, and more access to information and adopt on average more best practices. However, there is significant heterogeneity when looking at individual best practices, with women’s decision-making power or access to resources particularly important for specific practices such as sowing in rows. This study implies that designing more gender-sensitive agricultural programs and extension services in Ethiopia – specifically on practices relevant to women and men – can increase best practice adoption, with the ultimate aim of increasing productivity and income for teff farming households, and empowering women. Since male and female farmers are involved in different practices, access to resources and decision-making power have different impacts depending on the gender of the respondent and the practice analyzed, and there is no “one size fits all” solution to improve teff farming productivity