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

Abstract

BackgroundThe 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.MethodsThe 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.ResultsOverall, 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.ConclusionsResults 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 registrationRegistration at Clinicaltrials.gov (ID# NCT01073475)

Determinants of antenatal care booking among pregnant women in selected hospitals in Embu county, Kenya

“…It is evident from the results that majority of the respondents initiated their antenatal clinics in the third trimester; this is in line with studies done by Bucher et al (2015) and Linda (2015) which also found pregnant mothers to book for their antenatal clinics late in pregnancy…”

“…Most of the men do not accompany their spouses to the clinics (Kwambai et al, 2013). In another study, pregnant women in Kenya were reported to initiate antenatal care clinics in the second and third trimesters compared to other countries which were under study (Bucher et al, 2015). Mothers feared to be reprimanded by health care providers, others cited mistimed conception, experience of previous pregnancy especially those who suffered complications motivated the pregnant mothers to initiate antenatal clinics early.…”

Diagnostic Accuracy of Neonatal Assessment for Gestational Age Determination: A Systematic Review

“…7 Furthermore, the timing of the first visit for antenatal care is late, occurring typically late in the second trimester. 8,9 Moreover, access to ultrasonography is low, with <7% of pregnant women having access to ultrasound in rural sub-Saharan Africa. 4 Traditional sonography in late pregnancy is notably inaccurate for determining GA (±4 weeks).…”

Reducing stillbirths in low‐income countries

“…Nulliparity (22,24) Male fetus (24) Low education or literacy levels (3,22,24,27) Low socio-economic status (3,14,22,24) Younger or older age (24,27) Very low body mass index or obesity (22) Alcohol, tobacco or other drug use (23) Previous pregnancy loss (3,22) Maternal anemia (24,27) Delivery at ≥41 weeks of gestational (25) Medical care factors Lack of access to or inadequate antenatal care (21,22,45,48) Lack of access to or inadequate hospital care (21,22,43,45) …”

“…Simply noting that a visit took place does not indicate whether the mother was screened for Rh disease, syphilis or human immunodeficiency virus, was given a bed-net or treated prophylactically for malaria, given iron and vitamins for anemia prevention or treatment or had her blood pressure taken and urine tested for protein to diagnose preeclampsia (48). Equally important, counting the number of visits does not tell us whether any visits were performed late in the third trimester when preeclampsia and FGR often become apparent for the first time.…”