Antenatal health education with early postnatal booking and postnatal clinic attendance in primary health care centers in Bahrain: a quasi-experimental study
6 affiliations
- 1Clinical Master in Family Medicine Program, Department of Family and Community Medicine, College of Medicine and Health Sciences, Arabian Gulf University
- 2Primary Health Care Centers
- 3Institut Pasteur de Tunis
- 4Department of Family and Community Medicine, College of Medicine and Health Sciences, Arabian Gulf University
- 5American Mission Hospital
- 6Department of Family Medicine, Faculty of Medicine, Capital University
Abstract
Introduction: Postnatal care detects and manages complications in the weeks after delivery, yet in 2019 only 29% of women attending antenatal clinics in Bahrain’s primary health care (PHC) centers went on to attend the postnatal visit. We asked whether an antenatal intervention combining a standardized health-education session with early postnatal booking was associated with better knowledge of and attitudes toward postnatal care, and with higher postnatal clinic attendance.
Methods: In a non-randomized quasi-experimental study, pregnant women at 36 weeks of gestation or above were enrolled at four PHC centers (two intervention, two control) between 21 March and 20 June 2024. Intervention-group women received a midwife-delivered education session, QR-coded material, and an early postnatal appointment; controls received standard care. Knowledge and attitude were measured before and immediately after the session in the intervention arm and once, at enrolment, in the control arm. Attendance was ascertained from electronic mother-and-child health records in both arms. Groups were compared with t -tests, chi-square or Fisher’s exact tests, and logistic regression adjusted for baseline differences.
Results: Of 193 women approached, 175 (81 intervention, 94 control) were enrolled. Within the intervention arm, knowledge rose from 2.16 to 8.48 of 9 and attitude from 25.79 to 35.89 of 40 (both p < 0.001); because the control arm was assessed only once, these within-group changes cannot be attributed to the intervention. Attendance was 72.7% in the intervention arm versus 41.3% in controls (odds ratio 3.79, 95% CI 1.98–7.27; adjusted odds ratio 5.55, 95% CI 2.04–15.08). Knowledge and attitude did not independently predict attendance. Attendance varied widely between the two control centers (26.5 and 58.1%), and the intraclass correlation of 0.091 implies an effective sample of about 36 women.
Conclusion: Antenatal education with early postnatal booking was associated with substantially higher postnatal clinic attendance. With four non-randomized centers and between-center variation as large as the difference between arms, the design cannot separate an intervention effect from center-level differences. Early booking with structured counseling may be a feasible strategy for improving postnatal-care uptake and warrants evaluation in a cluster-randomized design.
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BibTeX
@article{alhaddad2026antenatal,
title = {{Antenatal health education with early postnatal booking and postnatal clinic attendance in primary health care centers in Bahrain: a quasi-experimental study}},
author = {Maitham E. E. Alhaddad and Mahmood A. H. Hubail and Maryam M. A. Rashed and Isa B. S. Alnajjar and Tasneem K. S. Husain and Fatema A. AlAali and Hala Al Asoomi and Basheer Makarem and Sadok Chlif and Fatema Habbash and Amer Almarabheh and Afif Ben Salah and Mohamed Hany Shehata},
journal = {Frontiers in Public Health},
year = {2026},
month = oct,
doi = {10.3389/fpubh.2026.1938634},
url = {https://www.frontiersin.org/articles/10.3389/fpubh.2026.1938634/full},
note = {CC BY 4.0},
}
RIS
TY - JOUR
TI - Antenatal health education with early postnatal booking and postnatal clinic attendance in primary health care centers in Bahrain: a quasi-experimental study
AU - Maitham E. E. Alhaddad
AU - Mahmood A. H. Hubail
AU - Maryam M. A. Rashed
AU - Isa B. S. Alnajjar
AU - Tasneem K. S. Husain
AU - Fatema A. AlAali
AU - Hala Al Asoomi
AU - Basheer Makarem
AU - Sadok Chlif
AU - Fatema Habbash
AU - Amer Almarabheh
AU - Afif Ben Salah
AU - Mohamed Hany Shehata
PY - 2026
DA - 2026/10/20
JO - Frontiers in Public Health
DO - 10.3389/fpubh.2026.1938634
UR - https://www.frontiersin.org/articles/10.3389/fpubh.2026.1938634/full
AB - Introduction: Postnatal care detects and manages complications in the weeks after delivery, yet in 2019 only 29% of women attending antenatal clinics in Bahrain’s primary health care (PHC) centers went on to attend the postnatal visit. We asked whether an antenatal intervention combining a standardized health-education session with early postnatal booking was associated with better knowledge of and attitudes toward postnatal care, and with higher postnatal clinic attendance. Methods: In a non-randomized quasi-experimental study, pregnant women at 36 weeks of gestation or above were enrolled at four PHC centers (two intervention, two control) between 21 March and 20 June 2024. Intervention-group women received a midwife-delivered education session, QR-coded material, and an early postnatal appointment; controls received standard care. Knowledge and attitude were measured before and immediately after the session in the intervention arm and once, at enrolment, in the control arm. Attendance was ascertained from electronic mother-and-child health records in both arms. Groups were compared with t -tests, chi-square or Fisher’s exact tests, and logistic regression adjusted for baseline differences. Results: Of 193 women approached, 175 (81 intervention, 94 control) were enrolled. Within the intervention arm, knowledge rose from 2.16 to 8.48 of 9 and attitude from 25.79 to 35.89 of 40 (both p < 0.001); because the control arm was assessed only once, these within-group changes cannot be attributed to the intervention. Attendance was 72.7% in the intervention arm versus 41.3% in controls (odds ratio 3.79, 95% CI 1.98–7.27; adjusted odds ratio 5.55, 95% CI 2.04–15.08). Knowledge and attitude did not independently predict attendance. Attendance varied widely between the two control centers (26.5 and 58.1%), and the intraclass correlation of 0.091 implies an effective sample of about 36 women. Conclusion: Antenatal education with early postnatal booking was associated with substantially higher postnatal clinic attendance. With four non-randomized centers and between-center variation as large as the difference between arms, the design cannot separate an intervention effect from center-level differences. Early booking with structured counseling may be a feasible strategy for improving postnatal-care uptake and warrants evaluation in a cluster-randomized design.
SN - 2296-2565
ER -