A prospective observational description of frequency and timing of antenatal care attendance and coverage of selected interventions from sites in Argentina, Guatemala, India, Kenya, Pakistan and Zambia

Sherri Bucher, Irene Marete, Constance Tenge, Edward A Liechty, Fabian Esamai, Archana Patel, Shivaprasad S Goudar, Bhalchandra Kodkany, Ana Garces, Elwyn Chomba, Fernando Althabe, Mabel Barreuta, Omrana Pasha, Patricia Hibberd, Richard J Derman, Kevin Otieno, K Hambidge, Nancy F Krebs, Waldemar A Carlo, Carolyne Chemweno, Robert L Goldenberg, Elizabeth M McClure, Janet L Moore, Dennis D Wallace, Sarah Saleem, Marion Koso-Thomas, Sherri Bucher, Irene Marete, Constance Tenge, Edward A Liechty, Fabian Esamai, Archana Patel, Shivaprasad S Goudar, Bhalchandra Kodkany, Ana Garces, Elwyn Chomba, Fernando Althabe, Mabel Barreuta, Omrana Pasha, Patricia Hibberd, Richard J Derman, Kevin Otieno, K Hambidge, Nancy F Krebs, Waldemar A Carlo, Carolyne Chemweno, Robert L Goldenberg, Elizabeth M McClure, Janet L Moore, Dennis D Wallace, Sarah Saleem, Marion Koso-Thomas

Abstract

Background: The Global Network for Women's and Children's Health Research is one of the largest international networks for testing and generating evidence-based recommendations for improvement of maternal-child health in resource-limited settings. Since 2009, Global Network sites in six low and middle-income countries have collected information on antenatal care practices, which are important as indicators of care and have implications for programs to improve maternal and child health. We sought to: (1) describe the quantity of antenatal care attendance over a four-year period; and (2) explore the quality of coverage for selected preventative, screening, and birth preparedness components.

Methods: The Maternal Newborn Health Registry (MNHR) is a prospective, population-based birth and pregnancy outcomes registry in Global Network sites, including: Argentina, Guatemala, India (Belgaum and Nagpur), Kenya, Pakistan, and Zambia. MNHR data from these sites were prospectively collected from January 1, 2010 - December 31, 2013 and analyzed for indicators related to quantity and patterns of ANC and coverage of key elements of recommended focused antenatal care. Descriptive statistics were generated overall by global region (Africa, Asia, and Latin America), and for each individual site.

Results: Overall, 96% of women reported at least one antenatal care visit. Indian sites demonstrated the highest percentage of women who initiated antenatal care during the first trimester. Women from the Latin American and Indian sites reported the highest number of at least 4 visits. Overall, 88% of women received tetanus toxoid. Only about half of all women reported having been screened for syphilis (49%) or anemia (50%). Rates of HIV testing were above 95% in the Argentina, African, and Indian sites. The Pakistan site demonstrated relatively high rates for birth preparation, but for most other preventative and screening interventions, posted lower coverage rates as compared to other Global Network sites.

Conclusions: Results from our large, prospective, population-based observational study contribute important insight into regional and site-specific patterns for antenatal care access and coverage. Our findings indicate a quality and coverage gap in antenatal care services, particularly in regards to syphilis and hemoglobin screening. We have identified site-specific gaps in access to, and delivery of, antenatal care services that can be targeted for improvement in future research and implementation efforts.

Trial registration: Registration at Clinicaltrials.gov (ID# NCT01073475).

Figures

Figure 1
Figure 1
Diagram of study population
Figure 2
Figure 2
Percentage of Global Network women who initiated ANC in the first, second, and third trimesters
Figure 3
Figure 3
Ranking of “good,” “fair,” and “poor” coverage by Global Network sites for 15 WHO ANC indicators of access and quality of care

References

    1. Lincetto O, Mothebesoane-Anoh S, Gomez P, Munjanja S. Opportunities for African Newborns. World Health Organization. pp. 51–62.
    1. Chama-Chiliba CM, Koch SF. Utilization of focused antenatal care in Zambia: examining individual- and community-level factors using a multilevel analysis. Health policy and planning. 2013;30(1):78–87.
    1. Pervin J, Moran A, Rahman M, Razzaque A, Sibley L, Streatfield PK. et al.Association of antenatal care with facility delivery and perinatal survival -a population-based study in Bangladesh. BMC Pregnancy and Childbirth. 2012;12(1):111. doi: 10.1186/1471-2393-12-111.
    1. Gupta S, Yamada G, Mpembeni R, Frumence G, Callaghan-Koru JA, Stevenson R, Brandes N, Baqui AH. Factors associated with four or more antenatal care visits and its decline among pregnant women in Tanzania between 1999 and 2010. PLoS One. 2014;9(7):e101893. doi: 10.1371/journal.pone.0101893.
    1. Hill J, Dellicour S, Bruce J, Ouma P, Smedley J, Otieno P. et al.Effectiveness of antenatal clinics to deliver intermittent preventive treatment and insecticide treated nets for the control of malaria in pregnancy in Kenya. PLoS One. 2013;8(6):e64913. doi: 10.1371/journal.pone.0064913.
    1. Hodgins S, D'Agostino A. The quality-coverage gap in antenatal care: toward better measurement of effective coverage. Glob Health Sci Pract. 2014;2(2):173–181. doi: 10.9745/GHSP-D-13-00176.
    1. Kyei NN, Chansa C, Gabrysch S. Quality of antenatal care in Zambia: a national assessment. BMC Pregnancy Childbirth. 2012;12:151. doi: 10.1186/1471-2393-12-151.
    1. Majrooh MA, Hasnain S, Akram J, Siddiqui A, Memon ZA. Coverage and quality of antenatal care provided at primary health care facilities in the 'Punjab' province of 'Pakistan'. PLoS One. 2014;9(11):e113390. doi: 10.1371/journal.pone.0113390.
    1. Thiam S, Kimotho V, Gatonga P. Why are IPTp coverage targets so elusive in sub-Saharan Africa? A systematic review of health system barriers. Malar J. 2013;12(1):353. doi: 10.1186/1475-2875-12-353.
    1. Karkee R, Lee AH, Binns CW. Birth preparedness and skilled attendance at birth in Nepal: implications for achieving millennium development goal 5. Midwifery. 2013;29(10):1206–1210. doi: 10.1016/j.midw.2013.05.002.
    1. van Eijk AM, Bles HM, Odhiambo F, Ayisi JG, Blokland IE, Rosen DH. et al.Use of antenatal services and delivery care among women in rural western Kenya: a community based survey. Reprod Health. 2006;3:2. doi: 10.1186/1742-4755-3-2.
    1. Atinga R, Baku A, Adongo P. Drivers of prenatal care quality and uptake of supervised delivery services in ghana. Ann Med Health Sci Res. 2014;4(Suppl 3):S264–S271.
    1. Goudar SS, Carlo WA, McClure EM, Pasha O, Patel A, Esamai F. et al.The Maternal and Newborn Health Registry Study of the Global Network for Women's and Children's Health Research. Int J Gynaecol Obstet. 2012;118(3):190–193. doi: 10.1016/j.ijgo.2012.04.022.
    1. Goudar SS, Stolka KB, Koso-Thomas M, McClure EM, Carlo WA, Goldenberg RL, The Global Network’s Maternal Newborn Health Registry: Data quality monitoring and performance metrics. Reproductive Health. 2015. in press .
    1. Bose CL, Bauserman M, Goldenberg RL, Goudar SS, McClure EM, Pasha O, The Global Network Maternal Newborn Health Registry: a multi-national, community-based registry of pregnancy outcomes. Reprouctive Health. 2015. in press .
    1. Pasha O, Goldenberg RL, McClure EM, Saleem S, Goudar SS, Althabe F. et al.Communities, birth attendants and health facilities: a continuum of emergency maternal and newborn care (the Global Network's EmONC trial) BMC Pregnancy Childbirth. 2010;10:82. doi: 10.1186/1471-2393-10-82.
    1. Andrew EV, Pell C, Angwin A, Auwun A, Daniels J, Mueller I, Phuanukoonnon S, Pool R. Factors affecting attendance at and timing of formal antenatal care: results from a qualitative study in Madang, Papua New Guinea. PLoS One. 2014;9(5):e93025. doi: 10.1371/journal.pone.0093025.
    1. Asundep NN, Carson AP, Turpin CA, Tameru B, Agidi AT, Zhang K, Jolly PE. Determinants of access to antenatal care and birth outcomes in Kumasi, Ghana. J Epidemiol Glob Health. 2013;3(4):279–288. doi: 10.1016/j.jegh.2013.09.004.
    1. Babalola S. Women's education level, antenatal visits and the quality of skilled antenatal care: a study of three African countries. J Health Care Poor Underserved. 2014;25(1):161–179. doi: 10.1353/hpu.2014.0049.
    1. Chama-Chiliba CM, Koch SF. Utilization of focused antenatal care in Zambia: examining individual- and community-level factors using a multilevel analysis. Health Policy Plan. 2015;30(1):78–87. doi: 10.1093/heapol/czt099.
    1. Ensor T, Quigley P, Green C, Razak Badru A, Kaluba D, Siziya S. Knowledgeable antenatal care as a pathway to skilled delivery: modelling the interactions between use of services and knowledge in Zambia. Health Policy Plan. 2014;29(5):580–588. doi: 10.1093/heapol/czt044.
    1. Gabrysch S, Cousens S, Cox J, Campbell OM. The influence of distance and level of care on delivery place in rural zambia: a study of linked national data in a geographic information system. PLoS Med. 2011;8(1):e1000394. doi: 10.1371/journal.pmed.1000394.
    1. Sialubanje C, Massar K, Hamer DH, Ruiter RA. Understanding the psychosocial and environmental factors and barriers affecting utilization of maternal healthcare services in Kalomo, Zambia: a qualitative study. Health Educ Res. 2014;29(3):521–532. doi: 10.1093/her/cyu011.
    1. Sialubanje C, Massar K, Hamer DH, Ruiter RA. Personal and environmental predictors of the intention to use maternal healthcare services in Kalomo, Zambia. Health Educ Res. 2014;29(6):1028–1040. doi: 10.1093/her/cyu057.
    1. van Eijk AM, Blokland IE, Slutsker L, Odhiambo F, Ayisi JG, Bles HM, Rosen DH, Adazu K, Lindblade KA. Use of intermittent preventive treatment for malaria in pregnancy in a rural area of western Kenya with high coverage of insecticide-treated bed nets. Trop Med Int Health. 2005;10(11):1134–1140. doi: 10.1111/j.1365-3156.2005.01497.x.
    1. Chomat AM, Grundy J, Oum S, Bermudez OI. Determinants of utilisation of intrapartum obstetric care services in Cambodia, and gaps in coverage. Global public health. 2011;6(8):890–905. doi: 10.1080/17441692.2011.572081.
    1. Chomat AM, Solomons NW, Montenegro G, Crowley C, Bermudez OI. Maternal health and health-seeking behaviors among indigenous Mam mothers from Quetzaltenango, Guatemala. Rev Panam Salud Publica. 2014;35(2):113–120.
    1. Mahajan H, Sharma B. Utilization of maternal and child health care services by primigravida females in urban and rural areas of India. ISRN Prev Med. 2014;2014:123918.
    1. Joshi C, Torvaldsen S, Hodgson R, Hayen A. Factors associated with the use and quality of antenatal care in Nepal: a population-based study using the demographic and health survey data. BMC Pregnancy Childbirth. 2014;14:94. doi: 10.1186/1471-2393-14-94.
    1. Joshi S, Sivaram A. How effective is Janani Suraksha Yojana? Ideas for India: For more evidence-based policy. 2014.
    1. Kisuule I, Kaye DK, Najjuka F, Ssematimba SK, Arinda A, Nakitende G, Otim L. Timing and reasons for coming late for the first antenatal care visit by pregnant women at Mulago hospital, Kampala Uganda. BMC Pregnancy Childbirth. 2013;13:121. doi: 10.1186/1471-2393-13-121.
    1. Majrooh MA, Hasnain S, Akram J, Siddiqui A, Shah F, Memon ZA. Accessibility of antenatal services at primary healthcare facilities in Punjab, Pakistan. J Pak Med Assoc. 2013;63(4 Suppl 3):S60–S66.
    1. Mansur AM, Rezaul KM, Mahmudul HM, S C. Quality of antenatal care in primary health care centers of bangladesh. J Family Reprod Health. 2014;8(4):175–181.
    1. Ouma PO, van Eijk AM, Hamel MJ, Sikuku ES, Odhiambo FO, Munguti KM. et al.Antenatal and delivery care in rural western Kenya: the effect of training health care workers to provide "focused antenatal care". Reprod Health. 2010;7:1. doi: 10.1186/1742-4755-7-1.
    1. Ishaque S, Yakoob MY, Imdad A, Goldenberg RL, Eisele TP, Bhutta ZA. Effectiveness of interventions to screen and manage infections during pregnancy on reducing stillbirths: a review. BMC Public Health. 2011;11(Suppl 3):S3. doi: 10.1186/1471-2458-11-S3-S3.
    1. Goldenberg RL, McClure EM, Saleem S, Reddy UM. Infection-related stillbirths. Lancet. 2010;375(9724):1482–1490. doi: 10.1016/S0140-6736(09)61712-8.
    1. Archana BR, Prasad SR, Beena PM, Okade R, Sheela SR, Beeregowda YC. Maternal and congenital syphilis in Karnataka, India. Southeast Asian J Trop Med Public Health. 2014;45(2):430–434.
    1. Arnesen L, Martinez G, Mainero L, Serruya S, Duran P. Gestational syphilis and stillbirth in Latin America and the Caribbean. Int J Gynaecol Obstet. 2014;17(14):241–245.
    1. Phiske MM. Current trends in congenital syphilis. Indian J Sex Transm Dis. 2014;35(1):12–20. doi: 10.4103/0253-7184.132404.
    1. Chopra S, Garg A, Chopra M, Ghosh A, Sreenivas V, Sood S, Kapil A, Das BK. Declining trends of Syphilis seroprevalance among antenatal clinic cases and STD clinic cases in a tertiary care centre: From January 2002 to December 2012. Indian J Med Microbiol. 2015;33(Suppl):126–128.
    1. Divala O, Michelo C, Ngwira B. Morbidity and mortality in HIV-exposed under-five children in a rural Malawi setting: a cohort study. J Int AIDS Soc. 2014;17(4 Suppl 3):19696.
    1. Aminu M, Unkels R, Mdegela M, Utz B, Adaji S, van den Broek N. Causes of and factors associated with stillbirth in low- and middle-income countries: a systematic literature review. BJOG. 2014;121(Suppl 4):141–153.
    1. Lassi ZS, Mansoor T, Salam RA, Das JK, Bhutta ZA. Essential pre-pregnancy and pregnancy interventions for improved maternal, newborn and child health. Reprod Health. 2014;11(Suppl 1):S2. doi: 10.1186/1742-4755-11-S1-S2.
    1. Thwaites CL, Beeching NJ, Newton CR. Maternal and neonatal tetanus. Lancet. 2014;19(14):60236–60231.
    1. Khan AA, Zahidie A, Rabbani F. Interventions to reduce neonatal mortality from neonatal tetanus in low and middle income countries--a systematic review. BMC Public Health. 2013;13:322. doi: 10.1186/1471-2458-13-322.
    1. Zaidi SM, Khowaja S, Kumar Dharma V, Khan AJ, Chandir S. Coverage, timeliness, and determinants of immunization completion in Pakistan: evidence from the Demographic and Health Survey (2006-07) Human Vacc Immunother. 2014;10(6):1712–1720. doi: 10.4161/hv.28621.
    1. McClure EM, Meshnick SR, Mungai P, Malhotra I, King CL, Goldenberg RL. et al.The association of parasitic infections in pregnancy and maternal and fetal anemia: a cohort study in coastal kenya. PLoS Negl Trop Dis. 2014;8(2):e2724. doi: 10.1371/journal.pntd.0002724.
    1. Ouedraogo S, Koura GK, Accrombessi MM, Bodeau-Livinec F, Massougbodji A, Cot M. Maternal anemia at first antenatal visit: prevalence and risk factors in a malaria-endemic area in Benin. Am J Trop Med Hyg. 2012;87(3):418–424. doi: 10.4269/ajtmh.2012.11-0706.
    1. National Malaria Control Centre Z. Guidelines for the Diagnosis and Treatment of Malaria. 4. 1. Vol. 41. Lusaka: Ministry of Health; 2014. pp. 1–8.
    1. Dhiman S, Yadav K, Goswami D, Das N, Baruah I, Singh L. Epidemiology and Risk Analysis of Malaria among Pregnant Women. Iran J Public Health. 2012;41(1):1–8.
    1. Singh A, Pallikadavath S, Ram F, Alagarajan M. Do antenatal care interventions improve neonatal survival in India? Health Policy Plan. 2014;29(7):842–848. doi: 10.1093/heapol/czt066. doi: 810.1093/heapol/czt1066. Epub 2013 Sep 1013.
    1. Pena-Rosas JP, De-Regil LM, Dowswell T, Viteri FE. Intermittent oral iron supplementation during pregnancy. Cochrane Database Syst Rev. 2012;7:CD009997.
    1. Bhutta ZA, Yakoob MY, Lawn JE, Rizvi A, Friberg IK, Weissman E, Buchmann E, Goldenberg RL. Stillbirths: what difference can we make and at what cost? Lancet. 2011;377(9776):1523–1538. doi: 10.1016/S0140-6736(10)62269-6.
    1. Maan MA, Hussain F, Iqbal J, Akhtar SJ. Sexually transmitted infections in Pakistan. Ann Saudi Med. 2011;31(3):263–269. doi: 10.4103/0256-4947.81541. doi: 210.4103/0256-4947.81541.
    1. Shah SA, Kristensen S, Memon MA, Usman G, Ghazi A, John R, Sathiakumar N, Vermund SH. Prevalence of syphilis among antenatal clinic attendees in Karachi: imperative to begin universal screening in Pakistan. J Pak Med Assoc. 2011;61(10):993–997.
    1. Yakoob MY, Lawn JE, Darmstadt GL, Bhutta ZA. Stillbirths: epidemiology, evidence, and priorities for action. Semin Perinatol. 2010;34(6):387–394. doi: 10.1053/j.semperi.2010.09.010.
    1. Afridi NK, Hatcher J, Mahmud S, Nanan D. Coverage and factors associated with tetanus toxoid vaccination status among females of reproductive age in Peshawar. J Coll Physicians Surg Pak. 2005;15(7):391–395.
    1. Ghosh R, Sharma AK. Intra- and inter-household differences in antenatal care, delivery practices and postnatal care between last neonatal deaths and last surviving children in a peri-urban area of India. J Biosoc Sci. 2010;42(4):511–530. doi: 10.1017/S0021932010000040.
    1. Baig-Ansari N, Badruddin SH, Karmaliani R, Harris H, Jehan I, Pasha O, Moss N, McClure EM, Goldenberg RL. Anemia prevalence and risk factors in pregnant women in an urban area of Pakistan. Food Nutr Bull. 2008;29(2):132–139.
    1. Ouma P, van Eijk AM, Hamel MJ, Parise M, Ayisi JG, Otieno K, Kager PA, Slutsker L. Malaria and anaemia among pregnant women at first antenatal clinic visit in Kisumu, western Kenya. Trop Med Int Health. 2007;12(12):1515–1523. doi: 10.1111/j.1365-3156.2007.01960.x.
    1. Adamu YM, Salihu HM. Barriers to the use of antenatal and obstetric care services in rural Kano, Nigeria. J Obstet Gynaecol. 2002;22(6):600–603. doi: 10.1080/0144361021000020349.
    1. Garces A, McClure EM, Chomba E, Patel A, Pasha O, Tshefu A. et al.Home birth attendants in low income countries: who are they and what do they do? BMC Pregnancy Childbirth. 2012;12:34. doi: 10.1186/1471-2393-12-34.
    1. Nigenda G, Langer A, Kuchaisit C, Romero M, Rojas G, Al-Osimy M. et al.Womens' opinions on antenatal care in developing countries: results of a study in Cuba, Thailand, Saudi Arabia and Argentina. BMC Public Health. 2003;3:17. doi: 10.1186/1471-2458-3-17.
    1. Tayler-Smith K, Zachariah R, Manzi M, Van den Boogaard W, Nyandwi G, Reid T. et ambulance referral network improves access to emergency obstetric and neonatal care in a district of rural Burundi with high maternal mortality. Trop Med Int Health. 2013;18(8):993–1001. doi: 10.1111/tmi.12121.
    1. Tura G, Afework MF, Yalew AW. The effect of birth preparedness and complication readiness on skilled care use: a prospective follow-up study in Southwest Ethiopia. Reprod Health. 2014;11:60. doi: 10.1186/1742-4755-11-60.
    1. Pasha O, Saleem S, Ali S, Goudar SS, Garces A, Esamai F, Diverging maternal, fetal and neonatal outcomes: Pakistan and other low and middle income countries in the Global Network’s Maternal Newborn Health Registry. Reproductive Health. 2015. in press .
    1. Marete I, Tenge C, Chemweno C, Bucher S, Pasha O, Ramadurg UV, Lost to follow-up among pregnant women in a multi-site community based maternal and newborn health registry: A prospective study. Reproductive Health. in press .
    1. Goldenberg RL, McClure EM, Bhutta ZA, Belizan JM, Reddy UM, Rubens CE, Mabeya H, Flenady V, Darmstadt GL. Stillbirths: the vision for 2020. Lancet. 2011;377(9779):1798–1805. doi: 10.1016/S0140-6736(10)62235-0.

Source: PubMed

Sponsor e collaboratori

Condizioni mediche

Interventi farmacologici

3
Sottoscrivi