#PAGE_PARAMS# #ADS_HEAD_SCRIPTS# #MICRODATA#

Impact of group antenatal care (G-ANC) versus individual antenatal care (ANC) on quality of care, ANC attendance and facility-based delivery: A pragmatic cluster-randomized controlled trial in Kenya and Nigeria


Autoři: Lindsay Grenier aff001;  Stephanie Suhowatsky aff001;  Mark M. Kabue aff002;  Lisa M. Noguchi aff001;  Diwakar Mohan aff003;  Shalmali Radha Karnad aff004;  Brenda Onguti aff005;  Eunice Omanga aff006;  Anthony Gichangi aff006;  Jonesmus Wambua aff006;  Charles Waka aff006;  Jaiyeola Oyetunji aff007;  Jeffrey M. Smith aff008
Působiště autorů: Department of Maternal and Newborn Health, Jhpiego, Baltimore, MD, United States of America aff001;  Department of Monitoring, Evaluation and Research, Jhpiego, Baltimore, MD, United States of America aff002;  Global Epidemiology and Control, Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States of America aff003;  Global Programs, Jhpiego, Nairobi, Kenya aff004;  Innovations and Technical Leadership, Jhpiego, Nairobi, Kenya aff005;  Department of Monitoring, Evaluation, and Research, Jhpiego, Nairobi, Kenya aff006;  Global Programs, Jhpiego, Abuja, Nigeria aff007;  Technical Leadership Office, Jhpiego, Baltimore, MD, United States of America aff008
Vyšlo v časopise: PLoS ONE 14(10)
Kategorie: Research Article
prolekare.web.journal.doi_sk: https://doi.org/10.1371/journal.pone.0222177

Souhrn

Background

Low quality and frequency of antenatal care (ANC) are associated with lower uptake of facility-based deliveries—a key intervention to reduce maternal and neonatal mortality. We implemented group ANC (G-ANC), an alternative service delivery model, in Kenya and Nigeria, to assess its impact on quality and attendance at ANC and uptake of facility-based delivery.

Methods

From October 2016‒January 2018, we conducted a facility-based, pragmatic, cluster-randomized controlled trial with 20 clusters per country. We recruited women <24 weeks gestation during their first ANC visit and enrolled women at intervention facilities who agreed to attend G-ANC in lieu of routine individual ANC. The G-ANC model consisted of five monthly 2-hour meetings with clinical assessments alongside structured gestationally specific group discussions and activities. Quality of care was defined as receipt of eight specific ANC interventions. Data were obtained through facility records and self-report during a home-based postpartum survey. Analysis was by intention to treat.

Findings

All women who completed follow up are included in the analysis (Nigeria: 1018/1075 enrolled women [94.7%], Kenya: 826/1013 [81.5%]). In Nigeria women in the intervention arm were more likely to have a facility-based delivery compared to those in the control arm (Nigeria: 76.7% [391/510] versus 54.1% [275/508]; aOR 2.30, CI 1.51–3.49). In both countries women in the intervention arm were more likely than those in the control arm to receive quality ANC (Nigeria: aOR 5.8, CI 1.98–17.21, p<0.001; Kenya: aOR 5.08, CI 2.31–11.16, p<0.001) and to attend at least four ANC visits (Nigeria: aOR 13.30, CI 7.69–22.99, p<0.001; Kenya: aOR 7.12, CI 3.91–12.97, p<0.001).

Conclusions

G-ANC was associated with higher facility-based delivery rates in Nigeria, where those rates associated with individual ANC were low. In both Kenya and Nigeria it was associated with a higher proportion of women receiving quality ANC and higher frequency of ANC visits.

Klíčová slova:

Neonatal care – Quality of care – Labor and delivery – Pregnancy – Kenya – Nigeria – Antenatal care – Global health


Zdroje

1. United Nations. Sustainable Development Goals. https://www.un.org/sustainabledevelopment/sustainable-development-goals/ (accessed March 7, 2019).

2. Every Woman Every Child. Global Strategy for Women’s, Children’s and Adolescents’ Health, 2016–2030. Geneva: World Health Organization; 2015. Available from: https://www.who.int/life-course/partners/global-strategy/ewec-globalstrategyreport-200915.pdf?ua Cited April 12, 2019.

3. Lawn JE, Blencowe H, Oza S, You D, Lee AC, Waiswa P, et al. Every Newborn: progress, priorities, and potential beyond. The Lancet. 2014; 384: 189–205.

4. UNICEF. Delivery care. 2018. https://data.unicef.org/topic/maternal-health/delivery-care/ (accessed March 7, 2019).

5. Moyer CA, Mustafa A. Drivers and deterrents of facility delivery in sub-Saharan Africa: a systematic review. Reproductive Health. 2013; 10:40 doi: 10.1186/1742-4755-10-40 23962135

6. Mbuagbaw L, Medley N, Darzi AJ, Richardson M, Habiba Garga K, Ongolo-Zogo P. Health system and community level interventions for improving antenatal care coverage and health outcomes. Cochrane Database of Systematic Reviews. 2015; 12:CD010994.

7. Berhan Y, Berhan A. Antenatal care as a means of increasing birth in the health facility and reducing maternal mortality: a systematic review. Ethiopian J Health Sci. 2014; 24 Suppl:93–104.

8. Chukwuma A, Wosu AC, Mbachu C, Weze K. Quality of antenatal care predicts retention in skilled birth attendance: a multilevel analysis of 28 African countries. BMC Pregnancy Childbirth. 2017; 17:152. doi: 10.1186/s12884-017-1337-1 28545422

9. Rosado C, Callaghan-Koru JA, Estifanos AS, Sheferaw E, Shay T, de Graft-Johnson J, et al. Effect of birth preparedness on institutional delivery in semiurban Ethiopia: A cross-sectional study. Annals of Global health. 2019; 85: 44. doi: 10.5334/aogh.920 30924620

10. Magoma M, Requejo J, Campbell O, Sousens S, Merialdi M, Filippi V. The effectiveness of birth plan in increasing use of skilled care at delivery and postnatal care in rural Tanzania: a cluster randomized trial. Tropical Medicine and International Health. 2013; 18: 435–443. doi: 10.1111/tmi.12069 23383733

11. Miltenburg AS, Roggeveen, Shields L, van Elteren M, van Roosmalen J, Stekelenburg J, et al. Impact of birth preparedness and complication readiness interventions on birth with a skilled attendant: A systematic review. 2015; PLoS ONE; 10: e014382. doi: 10.1371/journal.pone.0143382 26599677

12. Arunda M, Emmelin A, Asamoah BO. Effectiveness of antenatal care services in reducing neonatal mortality in Kenya: analysis of national survey data. Glob Health Action. 2017; 10: 1328796. doi: 10.1080/16549716.2017.1328796 28621201

13. Doku DT, Neupane S. Survival analysis of the association between antenatal care attendance and neonatal mortality in 57 low-and middle-income countries. International Journal of Epidemiology. 2017; 46: 1668–1677. doi: 10.1093/ije/dyx125 29040531

14. Kuhnt J, Vollmer S. Antenatal care services and its implications for vital and health outcomes of children: evidence from 193 surveys in 69 low-income and middle-income countries. BMJ Open. 2017; 7:e017122 doi: 10.1136/bmjopen-2017-017122 29146636

15. Soubeiga D, Gauvin L, Hatem MA, Johri M. Birth preparedness and complication readiness (BPCR) interventions to reduce maternal and neonatal mortality in developing countries: systematic review and meta-analysis. BMC Pregnancy and Childbirth. 2014; 14:129 doi: 10.1186/1471-2393-14-129 24708719

16. World Health Organization (WHO). WHO recommendations on antenatal care for a positive pregnancy experience. Geneva: WHO, 2016.

17. De Masi S, Bucagu M, Tuncalp O, Pena-Rosas JP, Lawrie T, Oladapo OT. Integrated person-centered health care for all women during pregnancy: Implementing World Health Organization recommendations on antenatal care for a positive pregnancy experience. Global Health: Science and Practice 2017. 5:197–201.

18. World Health Organization (WHO), Department of Reproductive Health and Research. WHO antenatal care randomized trial: manual for the implementation of the new model. Geneva: WHO, 2002.

19. Hodgins S, D'Agostino A. The quality-coverage gap in antenatal care: toward better measurement of effective coverage. Global health, science and practice. 2014; 2:173–81. doi: 10.9745/GHSP-D-13-00176 25276575

20. Benova L, Tunçalp Ö, Moran AC, Campbell OMR. Not just a number: examining coverage and content of antenatal care in low-income and middle-income countries. BMJ Glob Health. 2018; 3:e000779. doi: 10.1136/bmjgh-2018-000779 29662698

21. Kanyangarara M, Munos MK, Walker N. Quality of antenatal care service provision in health facilities across sub-Saharan Africa: Evidence from nationally representative health facility assessments. J Glob Health. 2017; 7:021101. doi: 10.7189/jogh.07.021101 29163936

22. Simkhada B, Teijlingen ER, Porter M, Simkhada P. Factors affecting the utilization of antenatal care in developing countries: systematic review of the literature. J Adv Nurs. 2008; 61:244–60. doi: 10.1111/j.1365-2648.2007.04532.x 18197860

23. Finlayson K, Downe S. Why do women not use antenatal services in low- and middle-income countries? A meta-synthesis of qualitative studies. PLoS Med. 2013; 10:e1001373. doi: 10.1371/journal.pmed.1001373 23349622

24. UNICEF. Antenatal care. 2018. https://data.unicef.org/topic/maternal-health/antenatal-care/ (accessed March 7, 2019).

25. Sharma J, O'Connor M, Rima Jolivet R. Group antenatal care models in low- and middle-income countries: a systematic evidence synthesis. Reprod Health. 2018; 15:38. doi: 10.1186/s12978-018-0476-9 29506531

26. Manant A, Dodgson JE. CenteringPregnancy: an integrative literature review. J Midwifery Womens Health. 2011; 56:94–102. doi: 10.1111/j.1542-2011.2010.00021.x 21429072

27. Catling CJ, Medley N, Foureur M, ryan C, Leap N, Teate A, et al. Group versus conventional antenatal care for women (Review). Cochrane Database Syst Rev. 2015; 2:CD007622.

28. Eluwa GI, Adebajo SB, Torpey K, Shittu O, Abdu-Aguye S, Pearlman D, et al. The effects of centering pregnancy on maternal and fetal outcomes in northern Nigeria; a prospective cohort analysis. BMC Pregnancy Childbirth. 2018; 18: 158. doi: 10.1186/s12884-018-1805-2 29751797

29. Patil CL, Klima CS, Steffen AD, Leshabari SC, Pauls H, Noor KF. Implementation challenges and outcomes of a randomized controlled pilot study of a group prenatal care model in Malawi and Tanzania. Int J Gynecol Obstet. 2017; 139:290–296.

30. Lori JR, Ofosu-Darkwah H, Boyd CJ, Banerjee T, Adanu RMK. Improving health literacy through group antenatal care: a prospective cohort study. BMC Pregnancy Childbirth. 2017; 17:228. doi: 10.1186/s12884-017-1414-5 28705179

31. Lori JR, Munro ML, Chuey MR. Use of a facilitated discussion model for antenatal care to improve communication. Int J Nurs Stud. 2016; 54:84–94. doi: 10.1016/j.ijnurstu.2015.03.018 25862409

32. Patil CL, Abrams ET, Klima C, Kaponda CP, Leshabari SC, Vonderheid SC, et. al. CenterPregnancy-Africa: a pilot of group anatenatal care to address millennium development goals. Midwifery. 2013; 29:1190–8. doi: 10.1016/j.midw.2013.05.008 23871278

33. Ford I, Norrie J. Pragmatic trials. N Engl J Med. 2016; 375:454–63. doi: 10.1056/NEJMra1510059 27518663

34. The World Bank. Health stats and service delivery indicators [cited 8 August 2019]. Database: DataBank [Internet]. Available from: https://data.worldbank.org/indicator

35. Maisha, National AIDS control council, Kenya. Kisumu county HIV and AIDS strategic plan 2014/2015-2018/2019. Available from: https://nacc.or.ke/mdocs-posts/kisumu-county-hiv-aids-strategic-plan/

36. Rising SS. Centering pregnancy. An interdisciplinary model of empowerment. J Nurse Midwifery. 1998; 43:46–54. 9489291

37. Buffington ST, Sibley LM, Beck DR, Armbruster DA, American College of Nurse-Midwives. Home based life saving skills: 2nd edition. Silver Spring, MD: ACNM, 2010.

38. Grenier L, Walker D, Lori JR, Klimas C. Transformative ANC service delivery: lessons from the Global Group Antenatal Care Collaborative [Presentation]. International Confederation of Midwives 31st Triennial Congress Toronto. Jun 18–22, 2017.

39. Ministry of Public Health and Sanitation and Ministry of Medical Services (Kenya). National Guidelines for Quality Obstetrics and Perinatal Care. Nairobi: Ministry of Health, 2011.

40. Ministry of Health (Kenya). Facilitator’s Guide: Providing Focused Antenatal Care. Nairobi: Ministry of Health, 2014.

41. National Population Commission (NPC): Nigeria Demographic and Health Survey 2013. Abuja, Nigeria, and Rockville, MD, USA; 2014.

42. Kenya National Bureau of Statistics (KNBS): Kenya Demographic and Health Survey 2014. Calverton, MD, USA; ICF International: 2015.

43. Kabue MM, Grenier L, Suhowatsky S, Oyetunji J, Ugwa E, Onguti B, et al. Group versus individual antenatal and first year postpartum care: Study protocol for a multi-country cluster randomized controlled trial in Kenya and Nigeria. Gates Open Res. 2018; 2:56. doi: 10.12688/gatesopenres.12867.1 30706056

44. World Health Organization (WHO). Everybody's business—strengthening health systems to improve health outcomes: WHO's framework for action. Geneva: WHO, 2007.


Článok vyšiel v časopise

PLOS One


2019 Číslo 10
Najčítanejšie tento týždeň
Najčítanejšie v tomto čísle
Kurzy

Zvýšte si kvalifikáciu online z pohodlia domova

Aktuální možnosti diagnostiky a léčby litiáz
nový kurz
Autori: MUDr. Tomáš Ürge, PhD.

Všetky kurzy
Prihlásenie
Zabudnuté heslo

Zadajte e-mailovú adresu, s ktorou ste vytvárali účet. Budú Vám na ňu zasielané informácie k nastaveniu nového hesla.

Prihlásenie

Nemáte účet?  Registrujte sa

#ADS_BOTTOM_SCRIPTS#