Effect of four or more antenatal care visits on facility delivery and early postnatal care services utilization in Uganda: a propensity score matched analysis

Mwebesa, Edson; Kagaayi, Joseph; Ssebagereka, Anthony; Nakafeero, Mary; Ssenkusu, John M.; Guwatudde, David; Tumwesigye, Nazarius Mbona

doi:10.1186/s12884-021-04354-8

Cited by 16 publications

(13 citation statements)

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“…Our study demonstrates that regular ANC visits may be the most critical measure to prevent the most stillbirths and neonatal deaths. At least 4 ANC visits may reduce leading causes of neonatal deaths . Ultrasonography access, timely caesarian delivery, trained staff for parturition, fetal heart rate monitoring, and improving maternal nutrition were among recommendations to improve ANC and obstetric care in our study, which is consistent with other studies .…”

Section: Discussionsupporting

confidence: 91%

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Prioritizing Health Care Strategies to Reduce Childhood Mortality

et al. 2022

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ImportanceAlthough child mortality trends have decreased worldwide, deaths among children younger than 5 years of age remain high and disproportionately circumscribed to sub-Saharan Africa and Southern Asia. Tailored and innovative approaches are needed to increase access, coverage, and quality of child health care services to reduce mortality, but an understanding of health system deficiencies that may have the greatest impact on mortality among children younger than 5 years is lacking.ObjectiveTo investigate which health care and public health improvements could have prevented the most stillbirths and deaths in children younger than 5 years using data from the Child Health and Mortality Prevention Surveillance (CHAMPS) network.Design, Setting, and ParticipantsThis cross-sectional study used longitudinal, population-based, and mortality surveillance data collected by CHAMPS to understand preventable causes of death. Overall, 3390 eligible deaths across all 7 CHAMPS sites (Bangladesh, Ethiopia, Kenya, Mali, Mozambique, Sierra Leone, and South Africa) between December 9, 2016, and December 31, 2021 (1190 stillbirths, 1340 neonatal deaths, 860 infant and child deaths), were included. Deaths were investigated using minimally invasive tissue sampling (MITS), a postmortem approach using biopsy needles for sampling key organs and fluids.Main Outcomes and MeasuresFor each death, an expert multidisciplinary panel reviewed case data to determine the plausible pathway and causes of death. If the death was deemed preventable, the panel identified which of 10 predetermined health system gaps could have prevented the death. The health system improvements that could have prevented the most deaths were evaluated for each age group: stillbirths, neonatal deaths (aged &lt;28 days), and infant and child deaths (aged 1 month to &lt;5 years).ResultsOf 3390 deaths, 1505 (44.4%) were female and 1880 (55.5%) were male; sex was not recorded for 5 deaths. Of all deaths, 3045 (89.8%) occurred in a healthcare facility and 344 (11.9%) in the community. Overall, 2607 (76.9%) were deemed potentially preventable: 883 of 1190 stillbirths (74.2%), 1010 of 1340 neonatal deaths (75.4%), and 714 of 860 infant and child deaths (83.0%). Recommended measures to prevent deaths were improvements in antenatal and obstetric care (recommended for 588 of 1190 stillbirths [49.4%], 496 of 1340 neonatal deaths [37.0%]), clinical management and quality of care (stillbirths, 280 [23.5%]; neonates, 498 [37.2%]; infants and children, 393 of 860 [45.7%]), health-seeking behavior (infants and children, 237 [27.6%]), and health education (infants and children, 262 [30.5%]).Conclusions and RelevanceIn this cross-sectional study, interventions prioritizing antenatal, intrapartum, and postnatal care could have prevented the most deaths among children younger than 5 years because 75% of deaths among children younger than 5 were stillbirths and neonatal deaths. Measures to reduce mortality in this population should prioritize improving existing systems, such as better access to antenatal care, implementation of standardized clinical protocols, and public education campaigns.

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Section: Discussionsupporting

confidence: 91%

“…18,19 Ultrasonography access, timely caesarian delivery, trained staff for parturition, fetal heart rate monitoring, and improving maternal nutrition were among recommendations toJAMA Network Open | Global Health…”

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confidence: 99%

Prioritizing Health Care Strategies to Reduce Childhood Mortality

et al. 2022

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“…Women who had four and more ANC visits between conception up to the delivery of the perinate ( 66 ).…”

Section: Methodsmentioning

confidence: 99%

Effect of optimal antenatal care on maternal and perinatal health in Ethiopia

2023

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IntroductionReceiving at least four antenatal care (ANC) visits have paramount importance on the health of mothers and perinates. In Ethiopia, several studies were conducted on ANC service utilization; however, limited studies quantified the effect of care on maternal and perinate health. In response to this gap, this study is conducted to quantify the effect of optimal ANC care (≥4 visits) on maternal and perinatal health among women who received optimal care in comparison to women who did not receive optimal care.MethodsThe study utilized the Ethiopian perinatal death surveillance and response (PDSR) system dataset. A total of 3,814 reviewed perinatal deaths were included in the study. Considering the nature of the data, preferential within propensity score matching (PWPSM) was performed to determine the effect of optimal ANC care on maternal and perinatal health. The effect of optimal care was reported using average treatment effects of the treated [ATT].ResultThe result revealed that optimal ANC care had a positive effect on reducing perinatal death, due to respiratory and cardiovascular disorders, [ATT = −0.015, 95%CI (−0.029 to −0.001)] and extending intrauterine life by one week [ATT = 1.277, 95%CI: (0.563–1.991)]. While it's effect on maternal health includes, avoiding the risk of having uterine rupture [ATT = −0.012, 95%CI: (−0.018 to −0.005)], improving the utilization of operative vaginal delivery (OVD) [ATT = 0.032, 95%CI: (0.001–0.062)] and avoiding delay to decide to seek care [ATT = −0.187, 95%CI: (−0.354 to −0.021)].ConclusionObtaining optimal ANC care has a positive effect on both maternal and perinatal health. Therefore, policies and interventions geared towards improving the coverage and quality of ANC services should be the top priority to maximize the benefit of the care.

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“…Routine ANC visits encourage women to take recommended interventions for healthy pregnancies and newborns and reduce adverse pregnancy outcomes. For example, evidence suggests that women who complete recommended ANC visits are more likely to give birth at a health facility and complete postnatal care (PNC) and give childbirth assisted by SBAs compared to a pregnant woman without ANC visits [ 17 , 18 ]. In addition, uptake of recommended ANC interventions requires better health facility readiness (e.g., provision of essential medicines, trained health workforces), delivery of interventions, and uptake by disadvantaged population groups [ 19 , 20 ].…”

Section: Introductionmentioning

confidence: 99%

Input, process, and output factors contributing to quality of antenatal care services: a scoping review of evidence

Khatri

Mengistu

Assefa

2022

BMC Pregnancy Childbirth

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Background High-quality antenatal care (ANC) provides a lifesaving opportunity for women and their newborns through providing health promotion, disease prevention, and early diagnosis and treatment of pregnancy-related health issues. However, systematically synthesised evidence on factors influencing the quality of ANC services is lacking. This scoping review aims to systematically synthesize the factors influencing in provision and utilisation of quality ANC services. Methods We conducted a scoping review of published evidence on the quality of ANC services. We searched records on four databases (PubMed, Scopus, Embase, and Google scholar) and grey literature from 1 to 2011 to 30 August 2021. We analysed data using Braun and Clarke’s thematic analysis approach. We followed Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR) guideline for the review. We explained themes using the Donabedian healthcare quality assessment model (input-process-output). Results Several inputs- and process-related factors contributed to suboptimal quality of ANC in many low and lower- or middle-income countries. Input factors included facility readiness (e.g., lack of infrastructure, provision of commodities and supplies, health workforce, structural and intermediary characteristics of pregnant women, and service delivery approaches). Processes-related factors included technical quality of care (e.g., lack of skilled adequate and timely care, and poor adherence to the guidelines) and social quality (lack of effective communication and poor client satisfaction). These input and process factors have also contributed to equity gaps in utilisation of quality ANC services. Conclusion Several input and process factors influenced the provision and utilization of optimum quality ANC services. Better health system inputs (e.g., availability of trained workforces, commodities, guidelines, context-specific programs) are essential to creating enabling facility environment for quality ANC services. Care processes can be improved by ensuring capacity-building activities for workforces (training, technical support visits), and mentoring staff working at peripheral facilities. Identifying coverage of quality ANC services among disadvantaged groups could be the initial step in designing and implementing targeted program approaches.

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Effect of four or more antenatal care visits on facility delivery and early postnatal care services utilization in Uganda: a propensity score matched analysis

Cited by 16 publications

References 54 publications

Prioritizing Health Care Strategies to Reduce Childhood Mortality

Prioritizing Health Care Strategies to Reduce Childhood Mortality

Effect of optimal antenatal care on maternal and perinatal health in Ethiopia

Input, process, and output factors contributing to quality of antenatal care services: a scoping review of evidence

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