A mixed methods analysis of factors affecting antenatal care content: A Syrian case study

Mourtada, Rima; Bottomley, Christian; Houben, Fiona; Bashour, Hyam; Campbell, Oona M. R.

doi:10.1371/journal.pone.0214375

Cited by 9 publications

(13 citation statements)

References 33 publications

(37 reference statements)

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“…Latin America and the Caribbean was the region with higher average scores and less variability between countries. Although our results show that globally more than half of women scored between 7 and 9 points (55%), 7% received no care during pregnancy, which may be explained by contextual and individual factors 25,26 . A systematic review of factors affecting the utilization of ANC in LMICs showed that maternal education, household income, cultural belief and place of residence have an important influence on ANC coverage.…”

Section: Discussioncontrasting

confidence: 69%

“…Although our results show that globally more than half of women scored between seven and nine points (55%), 7% received no care during pregnancy, which may be explained by contextual and individual factors. 18,19 A systematic review showed that maternal education, household income, cultural belief and place of residence have an important influence on ANC coverage in LMICs. 20…”

Section: Discussionmentioning

confidence: 99%

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A new content-qualified antenatal care coverage indicator: development and validation of a score using national health surveys

Arroyave

Saad

Victora

et al. 2020

Preprint

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Background: Good quality antenatal care (ANC) helps reducing adverse maternal and newborn outcomes, especially in low and middle-income countries (LMICs). Most of the currently used ANC indicators only measure contact with services. We aimed to create and validate a new indicator measured as a score, considering both contact and content, that can be used for monitoring. Methods: We used data from national surveys conducted in LMICs. Information on ANC was used to build an adequacy score (ANCq) that would be applicable to all women in need of ANC. Cronbach's alpha and factor analysis were used to assess the proposed indicator. We also used a convergent validation approach, exploring the association of our proposed indicator with neonatal mortality. Findings: The ANCq score was derived from seven variables related to contact with services and content of care ranging from zero to ten. Surveys from 63 countries with all variables were used. The validity assessment showed satisfactory results based on Cronbach's alpha (0.82) and factor analysis. The overall mean of ANCq was 6.7, ranging from 3.5 in Afghanistan to 9.3 in Cuba and the Dominican Republic. In most countries, the ANCq was inversely associated with neonatal mortality and the pooled for all surveys OR was 0.90 (95%CI 0.88-0.92). Interpretation: ANCq allows the assessment of ANC in LMICs considering contact with services and content of care. It also presented good validity properties, being a useful tool for assessing ANC coverage and adequacy of care in monitoring and accountability exercises. Funding: Bill & Melinda Gates Foundation (Countdown to 2030), the Wellcome, Associacao Brasileira de Saude Coletiva (ABRASCO) and Coordenacao de Aperfeicoamento de Pessoal de Nivel Superior (CAPES).

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Section: Discussioncontrasting

confidence: 69%

Section: Discussionmentioning

confidence: 99%

A new content-qualified antenatal care coverage indicator: development and validation of a score using national health surveys

Arroyave

Saad

Victora

et al. 2020

Preprint

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“…Latin America and the Caribbean was the region with higher average scores and less variability between countries. Although our results show that globally more than half of women scored between seven and nine points (55%), 7% received no care during pregnancy, which may be explained by contextual and individual factors [ 20 , 21 ]. A systematic review showed that maternal education, household income, cultural belief and place of residence have an important influence on ANC coverage in LMICs [ 22 ].…”

Section: Discussionmentioning

confidence: 65%

A new content-qualified antenatal care coverage indicator: Development and validation of a score using national health surveys in low- and middle-income countries

et al. 2021

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Background Good quality antenatal care (ANC) helps reduce adverse maternal and newborn outcomes, especially in low and middle-income countries (LMICs). Most of the currently used ANC indicators only measure contact with services. We aimed to create and validate a new indicator measured as a score, considering both contact and content, that can be used for monitoring. Methods We used data from national surveys conducted in LMICs. Information on ANC was used to build an adequacy score (ANCq) that would be applicable to all women in need of ANC. Cronbach's alpha and factor analysis were used to assess the proposed indicator. We also used a convergent validation approach, exploring the association of our proposed indicator with neonatal mortality. Results The ANCq score was derived from seven variables related to contact with services and content of care ranging from zero to ten. Surveys from 63 countries with all variables were used. The validity assessment showed satisfactory results based on Cronbach's alpha (0.82) and factor analysis. The overall mean of ANCq was 6.7, ranging from 3.5 in Afghanistan to 9.3 in Cuba and the Dominican Republic. In most countries, the ANCq was inversely associated with neonatal mortality and the pooled for all surveys Odds Ratio was 0.90 (95% CI = 0.88-0.92). Conclusions ANCq allows the assessment of ANC in LMICs considering contact with services and content of care. It also presented good validity properties, being a useful tool for assessing ANC coverage and adequacy of care in monitoring and accountability exercises.

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“…The Syrian con ict caused destruction to many health facilities in the country (16), consequently interrupting maternal health care for many women and likely deepening divisions in care quality. Postcon ict reconstruction of health services offers a unique opportunity to address the issues that existed precon ict, which contributed to the regional disparities in ANC coverage and patterns of use.…”

Section: Geographic Accessibilitymentioning

confidence: 99%

A qualitative study exploring barriers to adequate uptake of antenatal care in pre-conflict Syria: Implications for post conflict interventions addressing the demand-side barriers

Mourtada¹,

Bashour²,

Houben³

2020

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Background Until the onset of the conflict in 2011, Syria has made noticeable progress in reducing maternal mortality and morbidity. Despite the improvement in antenatal care (ANC) coverage and patterns of use, analyses of national surveys demonstrated wide regional variations in uptake, timing and number of visits even after controlling for women’s socio-demographic characteristics. The main aim of this study is to highlight the barriers to women’s adequate uptake of ANC that existed in Syria pre-conflict, comparing two governorates: Latakia, where uptake of antenatal care was high and Aleppo, where uptake of ANC was low. Methods This qualitative study carried out 30 in-depth interviews with (18–45 year old) pregnant women from Aleppo and Latakia and conducted 15 participant observation sessions in different types of health facilities that provide ANC. Participants were purposively recruited from randomly selected rural and urban, public and private health facilities, and independent midwives’ clinics, with onward sampling of women who did not attend ANC. Transcripts and fieldnotes were analyzed using the framework approach. Results Inadequate uptake of ANC in Aleppo included not attending ANC, discontinuing care or seeking care with unqualified providers. Three themes emerged that explained the disparities in uptake of ANC in Aleppo compared to Latakia: women’s assessment of their own health status in pregnancy, women’s evaluation of the risks of seeking ANC, and women’s appraisal of the value of different types of service providers. These evaluations were connected with the availability, accessibility (geographical and financial) and acceptability of ANC services however women’s views were shaped by the knowledge and prevailing opinions in their families and community. Conclusions Findings are utilized to discuss low-cost interventions addressing the disparities in uptake of ANC. Interventions should be aimed at increasing vulnerable women’s capacity and capabilities to make informed decisions. Women’s groups that foster education and empowerment and which have been effective in other low resource settings are worth exploring in Syria. Increased use of mobile phones and social media platforms that were not present pre-conflict, suggests mobile health technologies (mHealth) may present efficient platforms to deliver these interventions.

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A mixed methods analysis of factors affecting antenatal care content: A Syrian case study

Cited by 9 publications

References 33 publications

A new content-qualified antenatal care coverage indicator: development and validation of a score using national health surveys

A new content-qualified antenatal care coverage indicator: development and validation of a score using national health surveys

A new content-qualified antenatal care coverage indicator: Development and validation of a score using national health surveys in low- and middle-income countries

A qualitative study exploring barriers to adequate uptake of antenatal care in pre-conflict Syria: Implications for post conflict interventions addressing the demand-side barriers

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