Trends of antenatal care during pregnancy in low- and middle-income countries: Findings from the global network maternal and newborn health registry

Shiyam Sunder Tikmani, Sumera Aziz Ali, Sarah Saleem, Carla M. Bann, Musaku Mwenechanya, Waldemar A. Carlo, Lester Figueroa, Ana L. Garces, Nancy F. Krebs, Archana Patel, Patricia L. Hibberd, Shivaprasad S. Goudar, Richard J. Derman, Aleha Aziz, Irene Marete, Constance Tenge, Fabian Esamai, Edward Liechty, Sherri Bucher, Janet L. MooreElizabeth M. McClure, Robert L. Goldenberg

Research output: Contribution to journalReview article

Abstract

Background: Antenatal care (ANC) is an important opportunity to diagnose and treat pregnancy-related complications and to deliver interventions aimed at improving health and survival of both mother and the infant. Multiple individual studies and national surveys have assessed antenatal care utilization at a single point in time across different countries, but ANC trends have not often been studied in rural areas of low-middle income countries (LMICs). The objective of this analysis was to study the trends of antenatal care use in LMICs over a seven-year period. Methods: Using a prospective maternal and newborn health registry study, we analyzed data collected from 2011 to 2017 across five countries (Guatemala, India [2 sites], Kenya, Pakistan, and Zambia). Utilization of any ANC along with use of select services, including vitamins/iron, tetanus toxoid vaccine and HIV testing, were assessed. We used a generalized linear regression model to examine the trends of women receiving at least one and at least four antenatal care visits by site and year, controlling for maternal age, education and parity. Results: Between January 2011 and December 2017, 313,663 women were enrolled and included in the analysis. For all six sites, a high proportion of women received at least one ANC visit across this period. Over the years, there was a trend for an increasing proportion of women receiving at least one and at least four ANC visits in all sites, except for Guatemala where a decline in ANC was observed. Regarding utilization of specific services, in India almost 100% of women reported receiving tetanus toxoid vaccine, vitamins/iron supplementation and HIV testing services for all study years. In Kenya, a small increase in the proportion of women receiving tetanus toxoid vaccine was observed, while for Zambia, tetanus toxoid use declined from 97% in 2011 to 89% in 2017. No trends for tetanus toxoid use were observed for Pakistan and Guatemala. Across all countries an increasing trend was observed for use of vitamins/iron and HIV testing. However, HIV testing remained very low (<0.1%) for Pakistan. Conclusion: In a range of LMICs, from 2011 to 2017 nearly all women received at least one ANC visit, and a significant increase in the proportion of women who received at least four ANC visits was observed across all sites except Guatemala. Moreover, there were variations regarding the utilization of preventive care services across all sites except for India where rates were generally high. More research is required to understand the quality and influences of ANC.

Original languageEnglish (US)
JournalSeminars in Perinatology
DOIs
StatePublished - Jan 1 2019

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Prenatal Care
Registries
Tetanus Toxoid
Pregnancy
Guatemala
Pakistan
Vitamins
HIV
Zambia
India
Iron
Kenya
Infant Health
Maternal Health
Linear Models
Preventive Medicine
Pregnancy Complications
Maternal Age
Parity
Mothers

Keywords

  • Antenatal care
  • Low-middle income countries
  • Maternal health

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health
  • Obstetrics and Gynecology

Cite this

Trends of antenatal care during pregnancy in low- and middle-income countries : Findings from the global network maternal and newborn health registry. / Tikmani, Shiyam Sunder; Ali, Sumera Aziz; Saleem, Sarah; Bann, Carla M.; Mwenechanya, Musaku; Carlo, Waldemar A.; Figueroa, Lester; Garces, Ana L.; Krebs, Nancy F.; Patel, Archana; Hibberd, Patricia L.; Goudar, Shivaprasad S.; Derman, Richard J.; Aziz, Aleha; Marete, Irene; Tenge, Constance; Esamai, Fabian; Liechty, Edward; Bucher, Sherri; Moore, Janet L.; McClure, Elizabeth M.; Goldenberg, Robert L.

In: Seminars in Perinatology, 01.01.2019.

Research output: Contribution to journalReview article

Tikmani, SS, Ali, SA, Saleem, S, Bann, CM, Mwenechanya, M, Carlo, WA, Figueroa, L, Garces, AL, Krebs, NF, Patel, A, Hibberd, PL, Goudar, SS, Derman, RJ, Aziz, A, Marete, I, Tenge, C, Esamai, F, Liechty, E, Bucher, S, Moore, JL, McClure, EM & Goldenberg, RL 2019, 'Trends of antenatal care during pregnancy in low- and middle-income countries: Findings from the global network maternal and newborn health registry', Seminars in Perinatology. https://doi.org/10.1053/j.semperi.2019.03.020
Tikmani, Shiyam Sunder ; Ali, Sumera Aziz ; Saleem, Sarah ; Bann, Carla M. ; Mwenechanya, Musaku ; Carlo, Waldemar A. ; Figueroa, Lester ; Garces, Ana L. ; Krebs, Nancy F. ; Patel, Archana ; Hibberd, Patricia L. ; Goudar, Shivaprasad S. ; Derman, Richard J. ; Aziz, Aleha ; Marete, Irene ; Tenge, Constance ; Esamai, Fabian ; Liechty, Edward ; Bucher, Sherri ; Moore, Janet L. ; McClure, Elizabeth M. ; Goldenberg, Robert L. / Trends of antenatal care during pregnancy in low- and middle-income countries : Findings from the global network maternal and newborn health registry. In: Seminars in Perinatology. 2019.
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title = "Trends of antenatal care during pregnancy in low- and middle-income countries: Findings from the global network maternal and newborn health registry",
abstract = "Background: Antenatal care (ANC) is an important opportunity to diagnose and treat pregnancy-related complications and to deliver interventions aimed at improving health and survival of both mother and the infant. Multiple individual studies and national surveys have assessed antenatal care utilization at a single point in time across different countries, but ANC trends have not often been studied in rural areas of low-middle income countries (LMICs). The objective of this analysis was to study the trends of antenatal care use in LMICs over a seven-year period. Methods: Using a prospective maternal and newborn health registry study, we analyzed data collected from 2011 to 2017 across five countries (Guatemala, India [2 sites], Kenya, Pakistan, and Zambia). Utilization of any ANC along with use of select services, including vitamins/iron, tetanus toxoid vaccine and HIV testing, were assessed. We used a generalized linear regression model to examine the trends of women receiving at least one and at least four antenatal care visits by site and year, controlling for maternal age, education and parity. Results: Between January 2011 and December 2017, 313,663 women were enrolled and included in the analysis. For all six sites, a high proportion of women received at least one ANC visit across this period. Over the years, there was a trend for an increasing proportion of women receiving at least one and at least four ANC visits in all sites, except for Guatemala where a decline in ANC was observed. Regarding utilization of specific services, in India almost 100{\%} of women reported receiving tetanus toxoid vaccine, vitamins/iron supplementation and HIV testing services for all study years. In Kenya, a small increase in the proportion of women receiving tetanus toxoid vaccine was observed, while for Zambia, tetanus toxoid use declined from 97{\%} in 2011 to 89{\%} in 2017. No trends for tetanus toxoid use were observed for Pakistan and Guatemala. Across all countries an increasing trend was observed for use of vitamins/iron and HIV testing. However, HIV testing remained very low (<0.1{\%}) for Pakistan. Conclusion: In a range of LMICs, from 2011 to 2017 nearly all women received at least one ANC visit, and a significant increase in the proportion of women who received at least four ANC visits was observed across all sites except Guatemala. Moreover, there were variations regarding the utilization of preventive care services across all sites except for India where rates were generally high. More research is required to understand the quality and influences of ANC.",
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author = "Tikmani, {Shiyam Sunder} and Ali, {Sumera Aziz} and Sarah Saleem and Bann, {Carla M.} and Musaku Mwenechanya and Carlo, {Waldemar A.} and Lester Figueroa and Garces, {Ana L.} and Krebs, {Nancy F.} and Archana Patel and Hibberd, {Patricia L.} and Goudar, {Shivaprasad S.} and Derman, {Richard J.} and Aleha Aziz and Irene Marete and Constance Tenge and Fabian Esamai and Edward Liechty and Sherri Bucher and Moore, {Janet L.} and McClure, {Elizabeth M.} and Goldenberg, {Robert L.}",
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TY - JOUR

T1 - Trends of antenatal care during pregnancy in low- and middle-income countries

T2 - Findings from the global network maternal and newborn health registry

AU - Tikmani, Shiyam Sunder

AU - Ali, Sumera Aziz

AU - Saleem, Sarah

AU - Bann, Carla M.

AU - Mwenechanya, Musaku

AU - Carlo, Waldemar A.

AU - Figueroa, Lester

AU - Garces, Ana L.

AU - Krebs, Nancy F.

AU - Patel, Archana

AU - Hibberd, Patricia L.

AU - Goudar, Shivaprasad S.

AU - Derman, Richard J.

AU - Aziz, Aleha

AU - Marete, Irene

AU - Tenge, Constance

AU - Esamai, Fabian

AU - Liechty, Edward

AU - Bucher, Sherri

AU - Moore, Janet L.

AU - McClure, Elizabeth M.

AU - Goldenberg, Robert L.

PY - 2019/1/1

Y1 - 2019/1/1

N2 - Background: Antenatal care (ANC) is an important opportunity to diagnose and treat pregnancy-related complications and to deliver interventions aimed at improving health and survival of both mother and the infant. Multiple individual studies and national surveys have assessed antenatal care utilization at a single point in time across different countries, but ANC trends have not often been studied in rural areas of low-middle income countries (LMICs). The objective of this analysis was to study the trends of antenatal care use in LMICs over a seven-year period. Methods: Using a prospective maternal and newborn health registry study, we analyzed data collected from 2011 to 2017 across five countries (Guatemala, India [2 sites], Kenya, Pakistan, and Zambia). Utilization of any ANC along with use of select services, including vitamins/iron, tetanus toxoid vaccine and HIV testing, were assessed. We used a generalized linear regression model to examine the trends of women receiving at least one and at least four antenatal care visits by site and year, controlling for maternal age, education and parity. Results: Between January 2011 and December 2017, 313,663 women were enrolled and included in the analysis. For all six sites, a high proportion of women received at least one ANC visit across this period. Over the years, there was a trend for an increasing proportion of women receiving at least one and at least four ANC visits in all sites, except for Guatemala where a decline in ANC was observed. Regarding utilization of specific services, in India almost 100% of women reported receiving tetanus toxoid vaccine, vitamins/iron supplementation and HIV testing services for all study years. In Kenya, a small increase in the proportion of women receiving tetanus toxoid vaccine was observed, while for Zambia, tetanus toxoid use declined from 97% in 2011 to 89% in 2017. No trends for tetanus toxoid use were observed for Pakistan and Guatemala. Across all countries an increasing trend was observed for use of vitamins/iron and HIV testing. However, HIV testing remained very low (<0.1%) for Pakistan. Conclusion: In a range of LMICs, from 2011 to 2017 nearly all women received at least one ANC visit, and a significant increase in the proportion of women who received at least four ANC visits was observed across all sites except Guatemala. Moreover, there were variations regarding the utilization of preventive care services across all sites except for India where rates were generally high. More research is required to understand the quality and influences of ANC.

AB - Background: Antenatal care (ANC) is an important opportunity to diagnose and treat pregnancy-related complications and to deliver interventions aimed at improving health and survival of both mother and the infant. Multiple individual studies and national surveys have assessed antenatal care utilization at a single point in time across different countries, but ANC trends have not often been studied in rural areas of low-middle income countries (LMICs). The objective of this analysis was to study the trends of antenatal care use in LMICs over a seven-year period. Methods: Using a prospective maternal and newborn health registry study, we analyzed data collected from 2011 to 2017 across five countries (Guatemala, India [2 sites], Kenya, Pakistan, and Zambia). Utilization of any ANC along with use of select services, including vitamins/iron, tetanus toxoid vaccine and HIV testing, were assessed. We used a generalized linear regression model to examine the trends of women receiving at least one and at least four antenatal care visits by site and year, controlling for maternal age, education and parity. Results: Between January 2011 and December 2017, 313,663 women were enrolled and included in the analysis. For all six sites, a high proportion of women received at least one ANC visit across this period. Over the years, there was a trend for an increasing proportion of women receiving at least one and at least four ANC visits in all sites, except for Guatemala where a decline in ANC was observed. Regarding utilization of specific services, in India almost 100% of women reported receiving tetanus toxoid vaccine, vitamins/iron supplementation and HIV testing services for all study years. In Kenya, a small increase in the proportion of women receiving tetanus toxoid vaccine was observed, while for Zambia, tetanus toxoid use declined from 97% in 2011 to 89% in 2017. No trends for tetanus toxoid use were observed for Pakistan and Guatemala. Across all countries an increasing trend was observed for use of vitamins/iron and HIV testing. However, HIV testing remained very low (<0.1%) for Pakistan. Conclusion: In a range of LMICs, from 2011 to 2017 nearly all women received at least one ANC visit, and a significant increase in the proportion of women who received at least four ANC visits was observed across all sites except Guatemala. Moreover, there were variations regarding the utilization of preventive care services across all sites except for India where rates were generally high. More research is required to understand the quality and influences of ANC.

KW - Antenatal care

KW - Low-middle income countries

KW - Maternal health

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U2 - 10.1053/j.semperi.2019.03.020

DO - 10.1053/j.semperi.2019.03.020

M3 - Review article

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JO - Seminars in Perinatology

JF - Seminars in Perinatology

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