Salsabila Isha, Bambang Wibawarta
The impact of the COVID-19 pandemic on elementary school education in Japan
International journal of educational research open
early attendance antenatal care anc coupled goodquality care essential improving maternal child health outcomes however achieving outcomes subsaharan africa remains challenge study examines effects communityfacility health system strengthening model known 4byfour early anc attendance testing four conditions four months pregnancy four anc clinic visits migori county western kenya conducted mixed methods quasiexperimental study beforeafter interventional design assess impact 4byfour model anc attendance data collected august 2019 december 2020 two anc hospitals using quantitative data obtained facility anc registers analysed 707 baseline 894 endline unique anc numbers attendances based negative binomial regression logistic regression models used determine impact patient factors outcomes akaike information criterion aic likelihood ratio testing used compare models regular facility stock checks undertaken study sites assess availability anc profile tests analysis quantitative data conducted r v411 software additionally qualitative indepth interviews conducted 37 purposively sampled participants including pregnant mothers community health volunteers facility staff senior county health officials explore outcomes intervention interview data audiorecorded transcribed coded thematic analysis conducted nvivo significant 26 increase overall anc uptake facilities following intervention early anc attendance improved age groups including adolescents 22 baseline 33 endline p 0002 logistic regression models predicting early booking better fit data patient factors included age parity distance clinic p 0004 likelihood ratio testing suggesting patient factors associated early bookingthe proportion women receiving four tests four months increased 3 27894 haemoglobin malaria testing rates rising 8 4 respectively despite statistical significance p 0001 rates testing remained low testing uptake anc hampered frequent shortage profile commodities covered buffer stock low anc attendance first trimester qualitative data highlighted community health volunteerenhanced health education improved understanding motivated early ancseeking community pregnancy testing facilitated early detection referral particularly adolescent mothers challenges optimal anc attendance included insufficient knowledge ideal timing anc initiation financial constraints long distances facilities 4byfour model communityfacility health system strengthening potential improve early uptake anc testing pregnancy sustained improvement anc attendance requires concerted efforts improve care quality consistent availability anc commodities understand motivating factors addressing barriers anc research involving randomised control trials needed strengthen evidence models effectiveness inform potential scale