Providers adherence to essential contents of antenatal care services increases birth weight in Bahir Dar City Administration, north West Ethiopia: A prospective follow up study

Reproductive Health, Volume 15, No. 1, Year 2018

Interpretation

Background: Low birth weight (LBW) is one of the most important factors affecting child morbidity and mortality worldwide. Antenatal care (ANC) is an opportunity for reaching pregnant women with a number of interventions that may be vital to their health and well-being of their infants. However, data on the link between ANC quality and LBW remain limited especially in developing countries. Therefore, this study was aimed at investigating the effect of ANC service quality on birth weight among pregnant women attending ANC at public health facilities of Bahir Dar City Administration, Bahir Dar, Ethiopia using provision of essential services by providers as proxy for quality of care. Methods: Nine hundred seventy pregnant women with gestational age ≤ 16 weeks who came for their first ANC visit and selected by systematic sampling were enrolled and followed until delivery. Longitudinal data was collected during consultation with ANC providers using structured observation checklist. Women who gave birth at home and those who deliver a premature or still birth baby were excluded as data on birth weight could not be obtained for home deliveries and as the birth weight of the baby might be affected due to prematurity and still birth. Completed data were obtained from 718 women (since the rest women gave birth at home, we could not obtain birth weight data and we exclude them from analysis). The overall ANC service was considered as acceptable quality if women received ≥75th percentile of the essential ANC services. Generalized Estimating Equation was carried out to identify predictors of birth weight by controlling the cluster effect among women who received ANC services in the same facility. Results: The prevalence of low birth weight (< 2500 g) was 7.8% (95%CI = 6.0%, 9.7%) with 1.4% versus 10.5% among those who received acceptable and not acceptable quality ANC services respectively, P-value< 0.001. Maternal nutritional advice, iron-folic acid supplementation, tetanus toxoid vaccination, maternal educational status, parity and age were determinants for birth weight. Conclusion and recommendation: The study showed that access to quality ANC services led to good birth weight outcome. Strengthening adherence of providers to essential components of antenatal care through regular monitoring and need based capacity building is very important for reducing the risk of low birth weight. A facility based prospective follow up study was conducted from October 2015 to August 2016 in Bahir Dar City Administration, Amhara National Regional State, which is located in the North West part of Ethiopia. According to the Amhara National Regional State Bureau of Finance and Economic Development report, the projected population by 2015/16 was 297,775 (80.5% urban Vs 19.5% rural), of these 156,515 (52.6%) were females and there were 10,035 eligible pregnant women in the same year [8]. The study was conducted on seven public health facilities, one hospital and six health centers. All selected first visit pregnant women with gestational age ≤ 16weekss and attending ANC service during data collection period that were voluntary to participate verbal informed consent were included in the study. Women who gave birth at home were excluded as data on birth weight could not be obtained. In addition, those who gave a premature or still-birth baby; those who had any medical complication while pregnant (diabetes mellitus, heart disease, eclamptic and multiple pregnancy or give birth by caesarian section) were excluded as the birth weight of the baby might be affected due to the underlying conditions. The current study is part of a large follow up study with multiple objectives. The detail of the sample size calculation assumptions to address all objectives is described in the other part of the study published on Plos ONE [9]. For the current study a sample size was calculated with the predicted incidence of LBW babies as 6% among mothers completing four antenatal visits (compared to 25% among mothers with less than four visits) [10], and with 80% power, 95% confidence level and 15% non-response rate. The final calculated sample size was 304. However, to increase the power of the study, all 718 women who deliver a singleton baby at the study health facilities were included in the analysis. A structured observation check list to measure ANC quality was developed based on focused antenatal care protocol and used to observe the routine ANC practice for each visit. The weight of naked neonates was measured in kilograms to the nearest 100 g by using standard beam balance in the delivery room immediately after birth (preferably within 1 hour) by trained diploma midwives. Seven female diploma Midwives and two Bachelor of Science female Midwives were recruited as data collectors and supervisors respectively. Both data collectors and supervisors were not working in health facilities under the study. Training was given on the data collection instrument and how to approach and observe the ANC service provision. Pretest of the instrument, close supervision and daily checkup of the filled questionnaire for completeness were also done to maintain the data quality. Birth weight in kilograms; which was measured within 1 hour after birth. Quality of ANC service was the main exposure variable. Quality of ANC service was measured based on the interventions that the mother received during antenatal care: laboratory tests done like blood and urine tests, physical examinations like weight, height, blood pressure, providing TT vaccination, iron - folic acid supplementation, deworming, nutritional advice, information on immunization and breast feeding. If the essential ANC service was given it was coded as 1 otherwise 0 and a composite index for the overall ANC service quality was calculated. Percentile was computed to categorize the quality of the services a woman received. If she scored ≥75th percentile, of essential ANC services, ANC service was considered acceptable quality otherwise not [11]. Data were coded and entered into EPI data version3.1 and exported to SPSS version 20 for analysis. Descriptive statistics were used to describe the data. Generalized Estimating Equation linear regression analysis with robust estimator and exchangeable working correlation matrix was carried out to control the cluster effect of women who received ANC services within the same facility and to identify the predictor variables for birth weight of neonates. A p-value < 0.2 was considered to retain variables for the multivariable Generalized Estimating Equation linear regression analysis and P-value < 0.05 was considered to identify statistically significant predictors for birth weight.

AI Digest

Study Justification:

– Low birth weight is a significant factor affecting child morbidity and mortality worldwide.
– Antenatal care (ANC) is an opportunity to provide interventions that can improve the health of pregnant women and their infants.
– Limited data exists on the link between ANC quality and low birth weight in developing countries.
– This study aimed to investigate the effect of ANC service quality on birth weight among pregnant women in Bahir Dar City Administration, Ethiopia.

Study Highlights:

– The study included 718 pregnant women who received ANC services at public health facilities.
– The prevalence of low birth weight was 7.8%, with a significant difference between those who received acceptable quality ANC services (1.4%) and those who did not (10.5%).
– Maternal nutritional advice, iron-folic acid supplementation, tetanus toxoid vaccination, maternal educational status, parity, and age were determinants for birth weight.
– Access to quality ANC services led to better birth weight outcomes.

Study Recommendations:

– Strengthen adherence of providers to essential components of antenatal care through regular monitoring.
– Provide need-based capacity building for ANC providers.
– Emphasize the importance of maternal nutritional advice, iron-folic acid supplementation, and tetanus toxoid vaccination during ANC visits.
– Address maternal educational status, parity, and age as factors influencing birth weight.

Key Role Players:

– ANC providers: Ensure adherence to essential components of antenatal care.
– Health facility managers: Monitor and support ANC service quality.
– Health policymakers: Develop policies and guidelines to improve ANC service quality.
– Training institutions: Provide capacity building for ANC providers.

Cost Items for Planning Recommendations:

– Training programs for ANC providers.
– Monitoring and evaluation activities.
– Development and dissemination of policies and guidelines.
– Support for data collection and analysis.
– Communication and awareness campaigns.

Strength of Evidence

The strength of evidence for this abstract is 7 out of 10.
The evidence in the abstract is rated 7 because it provides a clear description of the study design, sample size, data collection methods, and statistical analysis. However, there is no mention of randomization or blinding, which could affect the strength of the evidence. To improve the evidence, the study could include randomization and blinding to reduce bias. Additionally, providing more details on the specific interventions and outcomes measured would enhance the clarity and applicability of the findings.

Abstract

A facility based prospective follow up study was conducted from October 2015 to August 2016 in Bahir Dar City Administration, Amhara National Regional State, which is located in the North West part of Ethiopia. According to the Amhara National Regional State Bureau of Finance and Economic Development report, the projected population by 2015/16 was 297,775 (80.5% urban Vs 19.5% rural), of these 156,515 (52.6%) were females and there were 10,035 eligible pregnant women in the same year [8]. The study was conducted on seven public health facilities, one hospital and six health centers. All selected first visit pregnant women with gestational age ≤ 16weekss and attending ANC service during data collection period that were voluntary to participate verbal informed consent were included in the study. Women who gave birth at home were excluded as data on birth weight could not be obtained. In addition, those who gave a premature or still-birth baby; those who had any medical complication while pregnant (diabetes mellitus, heart disease, eclamptic and multiple pregnancy or give birth by caesarian section) were excluded as the birth weight of the baby might be affected due to the underlying conditions. The current study is part of a large follow up study with multiple objectives. The detail of the sample size calculation assumptions to address all objectives is described in the other part of the study published on Plos ONE [9]. For the current study a sample size was calculated with the predicted incidence of LBW babies as 6% among mothers completing four antenatal visits (compared to 25% among mothers with less than four visits) [10], and with 80% power, 95% confidence level and 15% non-response rate. The final calculated sample size was 304. However, to increase the power of the study, all 718 women who deliver a singleton baby at the study health facilities were included in the analysis. A structured observation check list to measure ANC quality was developed based on focused antenatal care protocol and used to observe the routine ANC practice for each visit. The weight of naked neonates was measured in kilograms to the nearest 100 g by using standard beam balance in the delivery room immediately after birth (preferably within 1 hour) by trained diploma midwives. Seven female diploma Midwives and two Bachelor of Science female Midwives were recruited as data collectors and supervisors respectively. Both data collectors and supervisors were not working in health facilities under the study. Training was given on the data collection instrument and how to approach and observe the ANC service provision. Pretest of the instrument, close supervision and daily checkup of the filled questionnaire for completeness were also done to maintain the data quality. Birth weight in kilograms; which was measured within 1 hour after birth. Quality of ANC service was the main exposure variable. Quality of ANC service was measured based on the interventions that the mother received during antenatal care: laboratory tests done like blood and urine tests, physical examinations like weight, height, blood pressure, providing TT vaccination, iron – folic acid supplementation, deworming, nutritional advice, information on immunization and breast feeding. If the essential ANC service was given it was coded as 1 otherwise 0 and a composite index for the overall ANC service quality was calculated. Percentile was computed to categorize the quality of the services a woman received. If she scored ≥75th percentile, of essential ANC services, ANC service was considered acceptable quality otherwise not [11]. Data were coded and entered into EPI data version3.1 and exported to SPSS version 20 for analysis. Descriptive statistics were used to describe the data. Generalized Estimating Equation linear regression analysis with robust estimator and exchangeable working correlation matrix was carried out to control the cluster effect of women who received ANC services within the same facility and to identify the predictor variables for birth weight of neonates. A p-value < 0.2 was considered to retain variables for the multivariable Generalized Estimating Equation linear regression analysis and P-value < 0.05 was considered to identify statistically significant predictors for birth weight.

Materials

N/A

Innovations

The study titled “Providers adherence to essential contents of antenatal care services increases birth weight in Bahir Dar City Administration, north West Ethiopia: A prospective follow up study” investigated the effect of antenatal care (ANC) service quality on birth weight among pregnant women attending ANC at public health facilities in Bahir Dar City Administration, Ethiopia. The study found that access to quality ANC services led to better birth weight outcomes.

Based on the findings, the following recommendations can be developed into innovations to improve access to maternal health:

1. Strengthen adherence of providers to essential components of antenatal care: Implement training programs, workshops, and continuous professional development opportunities for healthcare providers to enhance their knowledge and skills in providing quality ANC services. Regular monitoring and need-based capacity building should be implemented to ensure that healthcare providers adhere to the essential components of antenatal care.

2. Implement regular monitoring and evaluation systems: Establish a robust monitoring and evaluation system to track the quality of ANC services provided by healthcare providers. This can involve routine assessments, audits, and feedback mechanisms to identify areas for improvement and ensure that providers are consistently delivering high-quality care.

3. Promote patient education and awareness: Enhance maternal education and awareness about the importance of ANC services. Implement community-based education programs, health campaigns, and the use of multimedia platforms to disseminate information about ANC services and the benefits of adhering to essential components of care.

4. Strengthen collaboration and coordination among stakeholders: Foster effective collaboration and coordination among healthcare providers, policymakers, community leaders, and other stakeholders. Establish partnerships, task forces, and committees to collectively address barriers to accessing quality ANC services and develop innovative solutions.

By implementing these recommendations, it is possible to improve access to maternal health by ensuring that pregnant women receive high-quality ANC services, leading to better birth weight outcomes and ultimately reducing the risk of low birth weight.

AI Innovations Description

Based on the findings, the following recommendation can be developed into an innovation to improve access to maternal health:

1. Strengthen adherence of providers to essential components of antenatal care: Regular monitoring and need-based capacity building should be implemented to ensure that healthcare providers adhere to the essential components of antenatal care. This can include training programs, workshops, and continuous professional development opportunities for healthcare providers to enhance their knowledge and skills in providing quality ANC services.

2. Implement regular monitoring and evaluation systems: Establishing a robust monitoring and evaluation system can help track the quality of ANC services provided by healthcare providers. This can involve routine assessments, audits, and feedback mechanisms to identify areas for improvement and ensure that providers are consistently delivering high-quality care.

3. Promote patient education and awareness: Enhancing maternal education and awareness about the importance of ANC services can empower pregnant women to actively seek and demand quality care. This can be achieved through community-based education programs, health campaigns, and the use of multimedia platforms to disseminate information about ANC services, including the benefits of adhering to essential components of care.

4. Strengthen collaboration and coordination among stakeholders: Effective collaboration and coordination among healthcare providers, policymakers, community leaders, and other stakeholders are crucial for improving access to maternal health. This can involve establishing partnerships, task forces, and committees to collectively address barriers to accessing quality ANC services and develop innovative solutions.

By implementing these recommendations, it is possible to improve access to maternal health by ensuring that pregnant women receive high-quality ANC services, leading to better birth weight outcomes and ultimately reducing the risk of low birth weight.

AI Innovations Methodology

The methodology used in the study titled “Providers adherence to essential contents of antenatal care services increases birth weight in Bahir Dar City Administration, north West Ethiopia: A prospective follow up study” involved the following steps:

1. Study Design: The study was a facility-based prospective follow-up study conducted from October 2015 to August 2016 in Bahir Dar City Administration, Ethiopia.

2. Sample Selection: A total of 970 pregnant women with gestational age ≤ 16 weeks who came for their first ANC visit were selected using systematic sampling. Women who gave birth at home and those who delivered premature or stillbirth babies were excluded from the analysis.

3. Data Collection: Longitudinal data was collected during ANC consultations using a structured observation checklist. The checklist assessed the provision of essential ANC services, including laboratory tests, physical examinations, vaccinations, supplementation, deworming, nutritional advice, and information on immunization and breastfeeding. The weight of newborns was measured within 1 hour after birth using a standard beam balance.

4. Data Analysis: Descriptive statistics were used to describe the data. Generalized Estimating Equation linear regression analysis with robust estimator and exchangeable working correlation matrix was conducted to control for the cluster effect of women who received ANC services within the same facility and identify predictor variables for birth weight.

5. Quality of ANC Service: The overall ANC service quality was determined based on the interventions received by the mother during ANC visits. If a woman scored ≥75th percentile of the essential ANC services, the ANC service was considered acceptable quality.

6. Statistical Analysis: The prevalence of low birth weight (

Authors & Co-Authors

Statistics:

Citations: 13

Authors: 3

Identifiers:

DOI: 10.1186/s12978-018-0610-8

Research Areas:

Community Interventions, Health System and Policy, Maternal Access, Maternal and Child Health, Noncommunicable Diseases, Quality of Care, Sexual and Reproductive Health, Workforce

Study Countries:

Ethiopia

Study Design:

Cohort Study, Cross Sectional Study, Grounded Theory

Study Approach:

Quantitative

Participants Gender:

Female