Thesis (M.S.)--Boston University

SAMMANFATTNING Bakgrund: syftet med mödrahälsovård är att erbjuda föräldrar som väntar barn frekventa undersökningar under graviditeten samt en förberedelse inför deras kommande föräldraroll. Mödrahälsovården erbjuder föräldrautbildning till föräldrarna. Fördelar med föräldrautbildningar grundar sig i att familjer skapar ett socialt nätverk, samhörighet och igenkännande med andra i samma situation. Syftet: att undersöka om blivande föräldrar skapade nätverk utifrån att de lärt känna varandra vid en föräldrautbildning under graviditeten. Metod: en deskriptiv enkätstudie utifrån kvantitativ och kvalitativ ansats. Enkäten bestod av 24 frågor, varav fyra bakgrundsfrågor, 19 frågor om föräldrautbildning och sista delen i enkäten var ett öppet fält där föräldrar kunde kommentera med egna ord. Chitvåtest användes i analys av kvantitativa variabler. Den öppna frågan analyserades med kvalitativ innehållsanalys. Resultat: majoriteten av föräldrarna ansåg att föräldragruppsträffarna var en inspirationskälla till att skapa nätverk med andra föräldrar. En del av föräldrarna ansåg att det geografiska avståndet inte hade en negativ inverkan på ett nätverk, medan andra ansåg att det hade en negativ inverkan. Vänner och BVC betydde mycket för föräldrar i deras nätverk. Drygt hälften av föräldrarna ansåg att det var viktigt/mycket viktigt att ha ett nätverk i sitt föräldraskap. De viktigaste anledningarna för föräldrarna var att delge varandra erfarenheter, utbyte av kunskap och socialt umgänge. Majoriteteten av föräldrarna ansåg att de kommer att ha ett fungerade nätverk med dessa föräldrar i framtiden. Slutsats: Föräldrautbildningarna ansågs vara meningsfulla och gav möjlighet för föräldrarna att skapa ett nätverk med andra föräldrar. Föräldrarna utbytte kunskap, erfarenhet, stöd och hade möjlighet till socialt umgänge. / ABSTRACT Background: the purpose of antenatal care is to offer parents who are expecting a child frequent examinations during pregnancy and preparation for their future role as parents. Maternal health services offer parent education to the parents. Advantages of parent training based on that families create a social network, belonging and identification with others in the same situation. Aim: was to investigate if prospective parents had created network on the basis that they got to know each other in a prenatal education during pregnancy. Method: a descriptive questionnaire study based on quantitative and qualitative approach. The questionnaire consisted of 24 questions, four background questions, 19 questions about parent education and final part of the questionnaire was an open field where parents have been able to comment with their own words. Chi two test was used in the analyze of quantitative variables. The open – ended question was analyzed with qualitative content analysis. Results: the majority of parents felt that parents' meetings were an inspiration to create a network with other parents. Some of the parents felt that the geographic distance did not have a negative impact on a network, while others felt that it had had a negative impact. Friends and BVC meant a lot for parents in their network. More than half of the parents felt that it was important/ very important to have a network in their parenting. The major reasons for the parents was to share experiences, exchange of knowledge and social interaction. The majority of parents felt that they will have a working network with these parents in the future. Conclusion: Prenatal education was considered to bemeaningful andgave the opportunityfor the parents tocreate a networkwith other parents. Parentsexchangedknowledge, experience, support andhad the opportunityto interact socially.

No description available.

SAMMANFATTNING Amningsfrekvensen i Sverige är lägre än vad som rekommenderas enligt Livsmedelverket och WHO. Sett ur ett folkhälsoperspektiv skulle mödrars och barns hälsa kunna förbättras om fler kvinnor ammade sina spädbarn mer exklusivt och under längre tid, varför bra metoder för amningsförberedelse bland blivande spädbarnsfamiljer behövs. Det amningsförberedande arbetet bör initieras av mödravårdsbarnmorskan redan under graviditeten.   Syfte: Att utforma en standardiserad mall för utförandet av amningsförberedande samtal under graviditet.   Metod: En kvalitativ pilotstudie genomförd med litteraturgranskning och fokusgruppintervju med barnmorskor, analyserade med innehållsanalys.   Resultat: Utifrån identifierade faktorer med visad positiv påverkan på amningsfrekvens samt barnmorskors kliniska erfarenhet utformades en standardiserad mall för amningsförberedande samtal. Mallen innehåller en individanpassad och en generell del. Den individanpassade delen behandlar tidigare amningserfarenheter, förväntningar inför kommande amning samt tankar kring brösten och deras funktion. Den generella delen behandlar information om bröst och bröstmjölk, amningsinformation, övriga tankar/frågor, EDS-screening samt fortsatt planering gällande amning.   Slutsats: Resultaten från litteraturgranskningen och fokusgruppsintervjustudien, med förslag på vad amningsförberedelse kan innehålla, överensstämmer till stor del. Barnmorskorna i fokusgruppsintervjustudien ger dock mer utförliga beskrivningar än de faktorer som sammanställts i litteraturgranskningen. Tillsammans har det gett en grund för utarbetandet av en standardiserad mall för amningsförberedande samtal. Fortsatt forskning får visa om samtalsmallen kan ge positiv effekt på amningsfrekvensen. Mallens användbarhet bör också vidare utvärderas. / ABSTRACT The breastfeeding frequency in Sweden is lower than the recommendation by the Swedish National Food Agency and WHO. From a public health perspective mothers´ and their children´s health would be improved if more women breastfed their infants more exclusively and during a longer period. Therefore good methods for breastfeeding preparation among parents to be is needed. The breastfeeding preparation should be initiated by the midwife at the maternity health care already during the women’s pregnancy.   Aim: To design a standardised guide for performing an anamnesis and care plan for breastfeeding during pregnancy.   Method: A qualitative pilot project based on literature review and focus group interviews with midwives, analysed by content analysis.   Results: A standardised guide for performing an anamnesis and care plan for breastfeeding were designed based on identified factors with proved positive impact on breastfeeding frequency and midwives´ clinical experiences in the interviews. The guide includes an individualised and a general part. The individualised part deals with previous breastfeeding experience, expectations for the coming breastfeeding and thoughts about breasts and their function. The general part deals with information about breasts and breast milk, information about breastfeeding, other thoughts/questions, EDS-screening and continued planning regarding breastfeeding.   Conclusion: The results of the literature review and the focus group interviews with suggestions on what breastfeeding preparation can include correspond to a large extent. Though the midwives in the focus group interviews gives more detailed and wide-ranging descriptions than the factors presented in the literature review. Altogether this has given a base for designing a standardised guide. Coming research will show if the guide can have positive impact on breastfeeding frequency. The usability of the guide should also be further evaluated.

The purpose of this study was to determine if there are differences in birth weight of infants, tobacco use during pregnancy, and Apgar scores of infants between pregnant adolescents who successfully complete a healthy pregnancy curriculum and those who do not and to further examine the adolescent mothers' perceptions of the major concepts included in a healthy pregnancy curriculum. The study involved the collection and analysis of retrospective data to determine differences in birth weight of infants, tobacco use during pregnancy, and Apgar scores of infants. Additionally, a questionnaire, focus group discussions, and follow-up interviews were conducted with former students of the healthy pregnancy curriculum to examine the adolescent mothers' perceptions of the major concepts in the healthy pregnancy curriculum. The participants answered questions regarding how important they thought each major concept is for inclusion in the healthy pregnancy curriculum, how much they learned about each major concept, and how helpful that information was in their own experiences. Analyses of the data did not show statistical differences between adolescents who successfully completed a healthy pregnancy curriculum and those who did not complete a healthy pregnancy curriculum regarding differences in birth weight of infants, tobacco use during pregnancy, and Apgar scores of infants. These findings of non-significance may be due to the small number of participants (n=50), non-participants (n=149), and the limited duration of the study data (1999 to 2003). A larger population over a longer period of time might yield different results. The findings from the qualitative data provided by the seven former students suggest that pregnant adolescents who successfully complete the class perceive the components of the healthy pregnancy curriculum as valuable and important. Topics that were indicated as particularly important were The Birth Process, Nutrition, Decision Making, and Family Planning. Participants further indicated changes in their attitudes for all ten topics and changes in behaviors in the areas of Human Reproduction, Nutrition, Health-Care Practices, Environmental Effects on the Unborn Baby, and Decision Making.

Background: Antenatal care is essential care that assists in maintaining a state of good health for the woman and her unborn baby. Globally the use of antenatal care services remains a challenge and this tendency is closely associated with maternal and neonatal mortalities and morbidities. South Africa has adopted a free service policy for pregnant women, their infants and for children up to the age of six. Despite this policy, the problem of limited utilisation of antenatal care services by pregnant women is still observed in this country and is associated with increased maternal and neonatal mortalities and morbidities.The purpose of the current proposed study was to explore and describe the reasons for limited utilisation of antenatal care services in the Mnquma sub-district, and to develop guidelines to assist the midwives to encourage the use of antenatal care services. Objectives:To explore and describe the reasons for the limited utilisation of antenatal care services by pregnant women at Mnquma sub-district.To explore and describe the knowledge of antenatal care services by the pregnant women.To develop guidelines to facilitate empowerment of midwives to enhance utilisation of antenatal care services by pregnant women in the Mnquma sub-district in Eastern Cape Province. The study was conducted in Mnquma sub-district during the months of July to January in 2016 using a qualitative, exploratory, descriptive and contextual research design. The research population were post-delivery women and the purposive sampling was used to identify women who met the stated criteria. One-on-one audio-taped semi-structured interviews were conducted and field notes were kept to justify some of the themes identified. Thirteen interviews were conducted and transcribed verbatim. Collected data was analysed using Tesch’s data analysis method. Trustworthiness was maintained through the standards of truth value, credibility, transferability, dependability and conformability. The ethical considerations of beneficence, justice, autonomy, non-maleficence and veracity were maintained. From the findings it emerged that the participants raised various concerns with regard to barriers influencing limited utilization of antenatal care services. The participants had limited knowledge of antenatal care services. Furthermore, participants recommended some solutions to enhance utilization of antenatal care services. Recommendations were made with regard to clinical practice, nursing education and nursing research. Guidelines were formulated to assist midwives to enhance the utilization of antenatal care services by pregnant women in the Mnquma sub-district in the Eastern Cape.

Lietuvoje išimtinai kūdikius iki 6 mėn. žindo tik 25, 7 proc. motinų, o 14 proc. jau nuo 1 gyvenimo mėnesio davė arbatos. Tyrimais yra nustatyta, kad žindymo ir laktacijos valdymo mokymas nėštumo metu, gali prailginti išimtinio žindymo trukmę.Tikslas – nustatyti nėščiųjų mokymo apie žindymo ir laktacijos valdymą įtaką išimtinio žindymo(IŽ) paplitimui, papildomo maitinimo(PM) įvedimo pradžiai bei įvertinti motinų žinias ir pastangas, siekiant spręsti su žindymu susijusias problemas.Uždaviniai: 1. Įvertinti nėščiųjų mokymo apie žindymą įtaką IŽ paplitimui ir trukmei; 2.Įvertinti nėščiųjų mokymo apie žindymą įtaką PM įvedimo pradžiai; 3.Įvertinti išklausiusių ir neišklausiusių mokymo apie žindymą motinų žinias ir pastangas siekiant spręsti su žindymu susijusias problemas; 4. Išsiaiškinti motinų nuostatas apie žindymo trukmę ir veiksnius, galinčius ją įtakoti; 5. Nustatyti motinų požiūrį į personalo pagalbą pradedant žindyti.Tyrimo metodas. Tyrimas buvo atliktas VU Sporto medicinos, reabilitacijos ir slaugos instituto ir RMC bazėje 2006-2008 metais. Naudojant anoniminę anketą-klausimyną buvo apklaustos 50 moterų, auginančios 6-18 mėn. amžiaus vaikus ir išklausiusios prenatalinį žindymo ir laktacijos valdymo pagrindų kursą (poveikio grupė(PG)), ir 50 moterų (kontrolinė grupė(KG)), auginančių tokio paties amžiaus vaikus ir neišklausiusios tokio kurso. Klausimyno pirmoje dalyje buvo siekiama išsiaiškinti moterų žindymo ir papildomo maisto įvedimo praktiką, nuostatas apie sėkmingo... [toliau žr. visą tekstą] / In Lithuania only 25.7% of babies are exclusively breastfed (BF) up to 6 months. Evidence has proved that prenatal teaching on BF and lactation management(LM) can prolong exclusive BF. Objective: to determine the influence of prenatal BF training over the rates of exclusive BF and the initiation of complementary feeding(CF) and to assess the mothers‘ knowledge and efforts in solving BF-related problems. Tasks: 1.Assess the influence of prenatal BF training over the rates and length of exclusive BF. 2. Assess the influence of prenatal BF training over the initiation of CF. 3. Assess the knowledge and efforts in solving BF-related problems by mothers who have undergone and who haven‘t undergone prenatal BF training. 4. Determine mothers‘ attitudes toward the length of BF and the factors influencing this length. 5. Determine mothers’ attitudes toward the personnel’s assistance at the initiation of BF. Methods: The investigation was carried out at the IRSMN at the MF of VU and the NNC in 2006 – 2008. The survey included 50 women raising children aged 6–18 months, having completed a prenatal BF and LM course (“intervention group” IG) and 50 - raising children of the same age but having not completed such course (“control group” CG). The first part of the anonymous questionnaire was aimed at determining the practices of BF and initiating CF, the successful BF factors, the assessment of assistance in BF and trust in nurses in solving BF-related problems; the second - a test aimed at... [to full text]

Les taux de mortalité maternelle et néonatale restent importants dans les pays en développement. L’ampleur de ces phénomènes est liée à une constellation de facteurs. Mais une part importante des issues défavorables de la grossesse et de la naissance est attribuable à des causes évitables et des comportements modifiables. Les interventions éducatives prénatales ont été élaborées dans le but d’adresser les facteurs affectant la demande de soins maternels et néonatals efficaces. Les stratégies éducatives ciblant les femmes enceintes incluent les conseils individuels, les sessions de groupes et la combinaison des deux stratégies. Ces stratégies visent à améliorer les connaissances sur les questions de santé maternelle et néonatale et à favoriser l’utilisation adéquate de soins qualifiés et les pratiques hygiéniques à domicile. L’Organisation Mondiale de la Santé (OMS) a diffusé dans les pays en développement des guides de pratiques en soins maternels et néonatals incluant les conseils de préparation à la naissance, lors des visites prénatales de routine. Toutefois, peu de données sont disponibles quant à l’efficacité et l’implantation effective de l’éducation prénatale dans les dits pays. Cette thèse cherche à mieux comprendre l’impact des programmes d’éducation prénatale implantés dans deux contextes à risques maternels et néonatals élevés au Burkina Faso. Rédigée sous forme d’articles, la thèse propose trois objectifs spécifiques : 1) examiner l’efficacité théorique des programmes d’éducation prénatale pour réduire la mortalité maternelle et néonatale dans les pays en développement; 2) évaluer l’association entre différents facteurs organisationnels et l’exposition des femmes aux conseils de préparation à la naissance qui font habituellement partie intégrante des programmes d’éducation prénatale implantés dans les services prénatals de routine; et 3) déterminer l’impact de recevoir des conseils de préparation à la naissance sur la probabilité d’accouchement institutionnel. Pour répondre au premier objectif, une méta-analyse de données issues d’essais randomisés a été effectuée. Concernant les réponses aux deux autres objectifs, les données d’une étude de cohorte rétrospective ont été utilisées. Cette étude observationnelle, conçue spécialement pour la thèse, a été menée dans deux districts à risques maternels et néonatals élevés (Dori et Koupela) du Burkina Faso. Les résultats observés à travers les trois investigations sont utiles pour l’avancement des connaissances et la pratique. La méta-analyse révèle que les interventions éducatives expérimentales sont associées à une réduction de 24% de la mortalité néonatale. Cette réduction atteint 30% dans les milieux à très forte mortalité néonatale. En situation de routine, divers facteurs organisationnels peuvent limiter ou faciliter la transmission des conseils éducatifs aux femmes usagères de soins prénatals. Au, Burkina Faso, les données analysées indiquent des fortes disparités entre les deux districts à l’étude. Les femmes du district de Koupela étaient significativement plus exposées aux conseils que celles de Dori. Au delà de cette disparité régionale, deux autres facteurs organisationnels sont fortement associés à l’exposition des femmes aux conseils de préparation à la naissance lors des visites prénatales de routine. Il s’agit de la disponibilité de supports de communication imagés dans l’établissement et le volume réduit de consultations par jour (moins de 20 consultations en moyenne versus 20 ou plus) augurant de moindres charges de travail pour le personnel. Enfin, les conseils reçus par les femmes sur les signes de complications obstétricales et sur les coûts des soins sont significativement associés à une probabilité plus élevée d’accoucher en institution; et ce, seulement dans le district de Dori où le taux d’accouchements institutionnels était relativement faible. En conclusion, l’éducation prénatale est bénéfique pour la sante maternelle et néonatale. Cependant, l’implantation et les effets sont hétérogènes selon les milieux. D’autres études expérimentales et observationnelles sont requises pour renforcer les évidences et investiguer plus en profondeur les facteurs de réussite afin de mieux orienter l’intervention. Les expérimentations futures devraient mesurer des issues de grossesses relatives à la mère (l’assistance qualifiée, les soins postpartum et la mortalité maternelle). Des études de cohorte prospectives avec des grands échantillons représentatifs permettraient de documenter de façon plus valide les événements et les expositions aux interventions durant la grossesse, l’accouchement et le postpartum. / Maternal and neonatal mortality remain high in developing countries. The magnitude of these phenomena is related to a constellation of factors. But a significant proportion of adverse pregnancy and birth outcome, in poor area, are attributable to preventable and behaviourally modifiable causes. Prenatal educational interventions have been developed in order to address the factors affecting the demand for effective maternal and neonatal care. Educational strategies targeting pregnant women include individual counselling, group sessions, and the combination of both strategies. These strategies aim to improve knowledge on issues related to maternal and newborn health and to promote the appropriate use of skilled care and hygiene practices at home. The World Health Organization (WHO) released practice guidelines in developing countries related to maternal and neonatal care including birth preparedness, during routine prenatal visits. However, few data are available about the effectiveness and implementation of effective prenatal education in these countries. This thesis aims to understand the impact of prenatal education programs in two contexts in Burkina Faso where maternal and neonatal risk are high. Written in the form of articles, the thesis addresses three specific objectives namely to: 1) examine the efficacy of prenatal education programs to reduce maternal and neonatal mortality in developing countries, 2) assess the association between different organizational factors and women’s exposure to birth preparedness messages during routine antenatal care, and 3) determine the impact of receiving birth preparedness advice on the likelihood of institutional delivery. For the first objective, a meta-analysis of data from randomized trials was conducted. To achieve the two other objectives, data from a retrospective cohort study were used. This observational study, designed specifically for the thesis, was conducted in two districts (Dori and Koupela) in Burkina Faso. The meta-analysis showed that educational interventions are associated with a 24% reduction in neonatal mortality. This reduction reached 30% in areas with very high neonatal mortality. In routine situations, organizational factors may limit or facilitate the transmission of educational advice to women using prenatal care. In Burkina Faso, the data indicate significant disparities between the two districts in the study. Women from Koupela district were significantly more exposed to advice than those from Dori. Beyond this regional disparity, two other organizational factors were strongly associated with exposure of women to birth preparedness counselling during routine prenatal visits. The first factor was the availability of print materials and aids (e.g., posters, pictures…), used by health professionals as communication support to provide prenatal clients with advice. The second factor was a lower volume of daily consultations (i.e., less than 20 consultations versus 20 or more) which meant lower workload for staff. Finally, advice received by women concerning signs of obstetric complications and costs of care were associated with a significantly higher likelihood of institutional deliveries but only in the district of Dori where the initial rate of institutional deliveries was relatively low. In conclusion, prenatal education is beneficial for maternal and newborn health. However, implementation and effect heterogeneities exist across contexts. Others experimental and observational studies are required to strengthen the evidence and more thoroughly investigate success factors in order to support policies. Future experiments should focus on maternal outcomes (i.e., skilled birth attendance, postpartum care, and maternal mortality). Prospective cohort studies with large and representative samples would allow for examination of events and exposures to interventions during pregnancy, childbirth, and post-partum.

Les taux de mortalité maternelle et néonatale restent importants dans les pays en développement. L’ampleur de ces phénomènes est liée à une constellation de facteurs. Mais une part importante des issues défavorables de la grossesse et de la naissance est attribuable à des causes évitables et des comportements modifiables. Les interventions éducatives prénatales ont été élaborées dans le but d’adresser les facteurs affectant la demande de soins maternels et néonatals efficaces. Les stratégies éducatives ciblant les femmes enceintes incluent les conseils individuels, les sessions de groupes et la combinaison des deux stratégies. Ces stratégies visent à améliorer les connaissances sur les questions de santé maternelle et néonatale et à favoriser l’utilisation adéquate de soins qualifiés et les pratiques hygiéniques à domicile. L’Organisation Mondiale de la Santé (OMS) a diffusé dans les pays en développement des guides de pratiques en soins maternels et néonatals incluant les conseils de préparation à la naissance, lors des visites prénatales de routine. Toutefois, peu de données sont disponibles quant à l’efficacité et l’implantation effective de l’éducation prénatale dans les dits pays. Cette thèse cherche à mieux comprendre l’impact des programmes d’éducation prénatale implantés dans deux contextes à risques maternels et néonatals élevés au Burkina Faso. Rédigée sous forme d’articles, la thèse propose trois objectifs spécifiques : 1) examiner l’efficacité théorique des programmes d’éducation prénatale pour réduire la mortalité maternelle et néonatale dans les pays en développement; 2) évaluer l’association entre différents facteurs organisationnels et l’exposition des femmes aux conseils de préparation à la naissance qui font habituellement partie intégrante des programmes d’éducation prénatale implantés dans les services prénatals de routine; et 3) déterminer l’impact de recevoir des conseils de préparation à la naissance sur la probabilité d’accouchement institutionnel. Pour répondre au premier objectif, une méta-analyse de données issues d’essais randomisés a été effectuée. Concernant les réponses aux deux autres objectifs, les données d’une étude de cohorte rétrospective ont été utilisées. Cette étude observationnelle, conçue spécialement pour la thèse, a été menée dans deux districts à risques maternels et néonatals élevés (Dori et Koupela) du Burkina Faso. Les résultats observés à travers les trois investigations sont utiles pour l’avancement des connaissances et la pratique. La méta-analyse révèle que les interventions éducatives expérimentales sont associées à une réduction de 24% de la mortalité néonatale. Cette réduction atteint 30% dans les milieux à très forte mortalité néonatale. En situation de routine, divers facteurs organisationnels peuvent limiter ou faciliter la transmission des conseils éducatifs aux femmes usagères de soins prénatals. Au, Burkina Faso, les données analysées indiquent des fortes disparités entre les deux districts à l’étude. Les femmes du district de Koupela étaient significativement plus exposées aux conseils que celles de Dori. Au delà de cette disparité régionale, deux autres facteurs organisationnels sont fortement associés à l’exposition des femmes aux conseils de préparation à la naissance lors des visites prénatales de routine. Il s’agit de la disponibilité de supports de communication imagés dans l’établissement et le volume réduit de consultations par jour (moins de 20 consultations en moyenne versus 20 ou plus) augurant de moindres charges de travail pour le personnel. Enfin, les conseils reçus par les femmes sur les signes de complications obstétricales et sur les coûts des soins sont significativement associés à une probabilité plus élevée d’accoucher en institution; et ce, seulement dans le district de Dori où le taux d’accouchements institutionnels était relativement faible. En conclusion, l’éducation prénatale est bénéfique pour la sante maternelle et néonatale. Cependant, l’implantation et les effets sont hétérogènes selon les milieux. D’autres études expérimentales et observationnelles sont requises pour renforcer les évidences et investiguer plus en profondeur les facteurs de réussite afin de mieux orienter l’intervention. Les expérimentations futures devraient mesurer des issues de grossesses relatives à la mère (l’assistance qualifiée, les soins postpartum et la mortalité maternelle). Des études de cohorte prospectives avec des grands échantillons représentatifs permettraient de documenter de façon plus valide les événements et les expositions aux interventions durant la grossesse, l’accouchement et le postpartum. / Maternal and neonatal mortality remain high in developing countries. The magnitude of these phenomena is related to a constellation of factors. But a significant proportion of adverse pregnancy and birth outcome, in poor area, are attributable to preventable and behaviourally modifiable causes. Prenatal educational interventions have been developed in order to address the factors affecting the demand for effective maternal and neonatal care. Educational strategies targeting pregnant women include individual counselling, group sessions, and the combination of both strategies. These strategies aim to improve knowledge on issues related to maternal and newborn health and to promote the appropriate use of skilled care and hygiene practices at home. The World Health Organization (WHO) released practice guidelines in developing countries related to maternal and neonatal care including birth preparedness, during routine prenatal visits. However, few data are available about the effectiveness and implementation of effective prenatal education in these countries. This thesis aims to understand the impact of prenatal education programs in two contexts in Burkina Faso where maternal and neonatal risk are high. Written in the form of articles, the thesis addresses three specific objectives namely to: 1) examine the efficacy of prenatal education programs to reduce maternal and neonatal mortality in developing countries, 2) assess the association between different organizational factors and women’s exposure to birth preparedness messages during routine antenatal care, and 3) determine the impact of receiving birth preparedness advice on the likelihood of institutional delivery. For the first objective, a meta-analysis of data from randomized trials was conducted. To achieve the two other objectives, data from a retrospective cohort study were used. This observational study, designed specifically for the thesis, was conducted in two districts (Dori and Koupela) in Burkina Faso. The meta-analysis showed that educational interventions are associated with a 24% reduction in neonatal mortality. This reduction reached 30% in areas with very high neonatal mortality. In routine situations, organizational factors may limit or facilitate the transmission of educational advice to women using prenatal care. In Burkina Faso, the data indicate significant disparities between the two districts in the study. Women from Koupela district were significantly more exposed to advice than those from Dori. Beyond this regional disparity, two other organizational factors were strongly associated with exposure of women to birth preparedness counselling during routine prenatal visits. The first factor was the availability of print materials and aids (e.g., posters, pictures…), used by health professionals as communication support to provide prenatal clients with advice. The second factor was a lower volume of daily consultations (i.e., less than 20 consultations versus 20 or more) which meant lower workload for staff. Finally, advice received by women concerning signs of obstetric complications and costs of care were associated with a significantly higher likelihood of institutional deliveries but only in the district of Dori where the initial rate of institutional deliveries was relatively low. In conclusion, prenatal education is beneficial for maternal and newborn health. However, implementation and effect heterogeneities exist across contexts. Others experimental and observational studies are required to strengthen the evidence and more thoroughly investigate success factors in order to support policies. Future experiments should focus on maternal outcomes (i.e., skilled birth attendance, postpartum care, and maternal mortality). Prospective cohort studies with large and representative samples would allow for examination of events and exposures to interventions during pregnancy, childbirth, and post-partum.

Strengthening marriages is important to the well-being of individuals, families and communities. The transition to parenthood brings with it particular risks and opportunities for marriage relationships, yet no interventions have been successful in accessing a large number of couples during this critical time prepare and strengthen them for the challenges of becoming parents. The healthcare system has an established education infrastructure (childbirth education) that interacts with a significant number of couples during the transition to parenthood and has become increasingly open to incorporating relationship strengthening efforts into existing programs. The Marriage Moments program was designed to access couples through this system. This new approach to marriage education employs a program design unique in three ways: the context of childbirth education, a low-intensity content based on a model of marital virtues, and a simple, self-administered format of materials that gives the program great flexibility and transportability that can be implemented in a variety of existing systems. Initial formative program evaluation data show that the program is well received by participating couples. Marriage Moments is currently being pilot tested to evaluate its effectiveness in strengthening marriage through the transition, but it is expected the program will be disseminated widely and reach numerous couples as they transition to parenthood.