Conectar
Mistreatment and obstetric violence constitute significant human rights violations with profound implications for maternal mental health. These detrimental practices persist globally, particularly in contexts where underfunded health systems, workforce shortages and entrenched gender inequalities intersect, depriving women of adequate psychosocial support and culturally sensitive mental healthcare. Although awareness of the immediate harms of mistreatment is increasing, its cumulative effects throughout the maternal care continuum remain insufficiently understood. This review will synthesise evidence on the impact of mistreatment on perinatal mental health, identify critical gaps and advocate for systemic change.
This systematic review and meta-analysis protocol complies with the guidelines set forth by the Preferred Reporting Items for Systematic Reviews and Meta-Analysis Protocols. A thorough literature search will be executed across multiple electronic databases, including CINAHL—Cumulative Index to Nursing and Allied Health Literature, Embase via Ovid, MEDLINE, PsycInfo, PubMed, Scopus, as well as other significant or specialised databases and grey literature. The review will incorporate only non-randomised study types and observational studies (cohort, cross-sectional, case-control), along with mixed-method and qualitative studies. Abstract and full-text screening will be performed by two reviewers using Covidence. The methodological quality of the included studies will be assessed using the Newcastle-Ottawa Scale for observational studies, the Risk of Bias in Non-Randomised Studies of Interventions, the Critical Appraisal Skills Programme and the Mixed Methods Appraisal Tool. Statistical heterogeneity will be evaluated using the Higgins test. Meta-analysis will be conducted using R statistical software V.4.4.4, employing random effects models to determine the weights. The study results will be reported sequentially, beginning with primary outcomes, followed by secondary outcomes and significant subgroup outcome analyses.
Ethical approval is not required as no original data will be collected. The findings of this review will be disseminated through publication and conference presentations.
CRD420251044379.
by Hailay Gebretnsae, Abadi Kidanemariam Berhe, Mache Tsadik, Akeza Awealom Asgedom, Mengistu Hagazi Tequare, Gebregziabher Berihu Gebrekidan, Gebru Hailu Redae, Tedros Bereket, Gebrekiros Gebremichael Meles, Mohamedawel Mohamedniguss Ebrahim, Yemane Berhane Tesfau, Gebremedhin Gebreegziabher Gebretsadik, Muzey Gebremichael Berhe, Hagos Degefa Hidru, Meresa Gebremedhin Weldu, Micheale Hagos Debesay, Gebrehaweria Gebrekurstos, Rieye Esayas, Haftom Gebrehiwot Woldearegay
BackgroundAlthough promoting high–quality care is particularly important in post–conflict settings, little is known about the effective coverage of antenatal care (ANC) services in post war Tigray. Thus, our study was aimed to assess the effective coverage of ANC services in post war Tigray, Northern Ethiopia.
MethodsA combined community and health facility–based cross–sectional study design was conducted in 24 randomly selected districts of Tigray, Northern Ethiopia from 29/01/2024–26/02/2024. Using multi–stage cluster sampling method, 2340 mothers of children under one year, 32 health facilities and 250 antenatal care (ANC) clients from the selected health facilities were included in the study. A pre–tested and structured questionnaire was used to collect the households’ data. Additionally, checklists were used to collect data on facility readiness and process quality. Data were collected by Open Data Kit (ODK) and analyzed using SPSS version 27. The effective coverage of antenatal care (ANC) services was analyzed among the target group of women by computing the proportion who received four or more ANC visits multiplied by the average facility readiness score, received iron–folate supplementation, and the average process quality score.
ResultsIn this study, 87.4% (95% Confidence Interval (CI): 86.1–88.8%) of women received their first antenatal care visit. However, only 10.7% (95% CI: 9.5–12.0%) of the women had their first visit before 12 weeks of gestation and the coverage of fourth and more ANC visits was 15.7% (95% CI: 14.2–17.2%). The overall ANC service readiness mean score was 55.6% (95%CI: 45.8–65.4%). Input–and intervention–adjusted ANC coverage was 8.7% and 7.1% respectively. The mean process quality score was 53.8% (95%CI: 51.0–56.6%), and the overall effective ANC coverage was 3.8%.
ConclusionsThe effective coverage of ANC services in post war Tigray is very low. To improve ANC uptake and ensure that pregnant women complete the recommended number of visits, it is crucial to enhance facility readiness by equipping essential ANC tracer items in conflict–affected Tigray region. Additionally, on-the-job training for healthcare providers working in maternal and neonatal departments is crucial to reinforce the basic components of ANC services and ensure adherence to standard protocols for delivering high quality of ANC services. Promoting early ANC initiation at health posts and encouraging pregnant women to maintain continuity in their ANC visits at nearest health centers/hospital are also vital for improving ANC4 + coverage and overall effective coverage of ANC services.
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