Antenatal care attendance and risk of low birthweight in Burkina Faso: a cross-sectional study

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Study Justification:
The study aimed to evaluate the association between antenatal care (ANC) attendance and low birthweight among newborns in Burkina Faso. Low birthweight is a significant contributor to infant mortality, and understanding the relationship between ANC attendance and birthweight can help inform strategies to improve birth outcomes.
Highlights:
– Data from 21,223 births in Burkina Faso were analyzed.
– The median number of ANC visits was 4, and 69% of mothers attended at least 4 visits.
– Mean birthweight was 2998 g, and 8.1% of infants were low birthweight.
– Newborns born to mothers who attended ≥4 ANC visits had a higher birthweight compared to those who attended

The strength of evidence for this abstract is 7 out of 10.
The evidence in the abstract is rated 7 because it is based on a cross-sectional study design, which is a relatively weak study design for establishing causality. However, the study utilized a large sample size (21,223 births) and adjusted for potentially confounding variables in their analysis. To improve the strength of the evidence, conducting a prospective cohort study or a randomized controlled trial would be recommended.

Background: Low birthweight is a major contributor to infant mortality. We evaluated the association between antenatal care (ANC) attendance and low birthweight among newborns in 5 regions of Burkina Faso. Methods: We utilized data from the baseline assessment of a randomized controlled trial evaluating azithromycin distribution during the neonatal period for prevention of infant mortality. Neonates were eligible for the trial if the weighed at least 2500 g at enrollment and were 8–27 days of age. Data on ANC attendance and birthweight was extracted from each child’s carnet de santé, a government-issued health card on which pregnancy and birth-related data are recorded. We used linear and logistic regression models adjusting for potentially confounding variables to evaluate the relationship between ANC attendance (as total number of visits and ≥ 4 antenatal care visits) and birthweight (continuously and categorized into < 2500 g versus ≥2500 g). Results: Data from 21,223 births were included in the analysis. The median number of ANC visits was 4 (interquartile range 3 to 5) and 69% of mothers attended at least 4 visits. Mean birthweight was 2998 g (standard deviation 423) and 8.1% of infants were low birthweight (< 2500 g). Birthweight was 63 g (95% CI 46 to 81 g, P < 0.001) higher in newborns born to mothers who had attended ≥4 ANC visits versus < 4 visits. The odds of low birthweight among infants born to mothers with ≥4 ANC visits was 0.71 (95% CI 0.63 to 0.79, P < 0.001) times the odds of low birthweight among infants born to mothers who attended < 4 ANC visits. Conclusions: We observed a statistically significant association between ANC attendance and birthweight, although absolute differences were small. Improving access to ANC for all women may help improve birth outcomes. Trial registration: The parent trial is registered at clinicaltrials.gov: NCT03682653; first registered 24 September 2018.

We utilized data from the baseline assessment of a randomized controlled trial evaluating whether a single oral dose of azithromycin administered during the neonatal period was effective for reducing infant mortality in Burkina Faso (clinicaltrials.gov {"type":"clinical-trial","attrs":{"text":"NCT03682653","term_id":"NCT03682653"}}NCT03682653) [11]. The trial was conducted in 44 primary healthcare facilities in 5 regions of Burkina Faso, including Centre, Boucle du Mouhoun, Cascade, Centre Ouest, and Hauts-Bassins. Enrollment lasted from April 2019 through December 2020. Facilities were in a mix of urban and rural settings. Because the parent trial was comparing oral azithromycin administered in the neonatal period to placebo, facilities were chosen to be within 4 h of a pediatric hospital that had pediatric surgical facilities in the case of infantile hypertrophic pyloric stenosis, a rare but serious condition that has been linked to azithromycin administration in observational studies [12]. Neonates were eligible for the trial if they were between 8 and 27 days of age, weighed at least 2500 g at enrollment, were able to feed orally, and did not have clinical signs of neonatal jaundice. Low birthweight babies were not excluded from the trial, but the child had to have gained enough weight to meet the trial’s weight-based enrollment criterion (2500 g) by the time they were 27 days of age to be able to participate in the parent trial and be included in this analysis. Only infants with birthweights recorded in the carnet de santé (government-issued health card) with complete data on antenatal care attendance were included in the present analysis. Neonates were recruited via contacting mothers who gave birth in the facilities and outreach during BCG vaccination days. The Institutional Review Boards at the University of California, San Francisco and the Comité National d’Ethique pour la Recherche (National Research Ethics Committee) in Ouagadougou, Burkina Faso reviewed and approved the study. Written informed consent was provided by the caregiver of each neonate enrolled in the trial. All study procedures were carried out in accordance with the Declaration of Helsinki and relevant guidelines and regulations. At enrollment, a baseline questionnaire was completed by the caregiver of each enrolled neonate. The questionnaire included the child’s age at enrollment and sex, maternal age and education (coded as none, primary, secondary, or higher than secondary school), and the number of times the mother had been pregnant. Questions related to the pregnancy included whether the child was a singleton or multiple birth and if the mother had given birth in a healthcare facility. We extracted data from the child’s health and vaccination card (carnet de santé) on the number of antenatal clinic visits attended by the mother and the neonate’s birthweight. We collected data on each healthcare facility included in the study, including whether it was in an urban or rural setting, if the facility has a physician on-site, and the number of non-physician clinicians, including nurses and midwives, employed by the facility. Because infants were not enrolled during pregnancy and gestational age testing is not widely available in the study area, information on gestational age was not collected. We evaluated the relationship between the number of antenatal care visits and 1) birthweight as a continuous variable using linear regression models and 2) low birthweight (defined as < 2500 g) using logistic regression models. All multivariable models were adjusted for maternal age, education, number of previous pregnancies, type of pregnancy (singleton vs multiple), the infant’s sex, region of the facility, if the facility was in an urban or rural setting, and if it had a physician onsite (as a proxy for level of care available at the facility). These variables were chosen because they were hypothesized to be confounders of the relationship between antenatal care attendance and birthweight. We chose this strategy as other strategies that rely on statistical criteria or comparison of adjusted and unadjusted effects may lead to omission of important but non-statistically significant confounders from the analysis and inappropriate adjustment for variables that are on the causal pathway between exposure and outcome [13]. We then evaluated the same outcomes using whether the mother had attended at least four antenatal care visits, adjusting for the same potentially confounding variables. We first ran a series of univariate models for antenatal care use and each confounding variable, and then a multivariable model for each exposure and outcome pair including all covariates. We did not base confounding decisions on statistical significance in the univariate model, due to known biases arising from relying on statistical criteria for confounder selection [14]. For all exposure-outcome pairs, we conducted a subgroup analysis among rural versus urban facilities to evaluate any differences the association between antenatal care use and birthweight by urbanicity. Due to the multilevel nature of the data, all models adjusted for clustering at the facility level using a Huber-White sandwich estimator. All analyses were conducted in Stata version 15.1 (StataCorp, College Station, TX).

Based on the provided description, here are some potential innovations that could improve access to maternal health:

1. Mobile Health (mHealth) Solutions: Implementing mobile health technologies, such as text messaging or mobile apps, to provide pregnant women with important information, reminders for antenatal care visits, and access to healthcare providers for consultations.

2. Telemedicine: Using telecommunication technologies to enable remote consultations between pregnant women and healthcare providers, reducing the need for in-person visits and improving access to medical advice and support.

3. Community Health Workers: Training and deploying community health workers to provide antenatal care services, education, and support to pregnant women in remote or underserved areas where healthcare facilities are limited.

4. Transport and Logistics Support: Developing transportation systems or programs to ensure pregnant women have access to reliable and affordable transportation to reach healthcare facilities for antenatal care visits and delivery.

5. Maternal Health Vouchers: Implementing voucher programs that provide pregnant women with financial assistance to cover the costs of antenatal care services, including transportation, consultations, and medications.

6. Public-Private Partnerships: Collaborating with private healthcare providers to expand access to antenatal care services, especially in areas where public healthcare facilities are insufficient.

7. Health Education and Awareness Campaigns: Conducting targeted campaigns to raise awareness about the importance of antenatal care and educate pregnant women and their families about the benefits and available services.

8. Improving Facility Infrastructure: Investing in the improvement and expansion of healthcare facilities, especially in rural areas, to ensure they have the necessary equipment, supplies, and skilled healthcare professionals to provide quality antenatal care services.

9. Integrating Maternal Health Services: Integrating antenatal care services with other healthcare services, such as family planning, immunization, and HIV testing, to provide comprehensive care and improve overall maternal and child health outcomes.

10. Empowering Women and Community Engagement: Promoting women’s empowerment and community engagement by involving them in decision-making processes, encouraging them to seek antenatal care, and addressing cultural and social barriers that may hinder access to maternal health services.

These innovations aim to address various barriers to accessing maternal health services, including geographical distance, lack of transportation, limited healthcare facilities, financial constraints, and lack of awareness or education. Implementing these innovations can help improve access to antenatal care and ultimately contribute to better maternal and child health outcomes.
AI Innovations Description
Based on the information provided, the recommendation to improve access to maternal health and address the issue of low birthweight in Burkina Faso is to focus on improving antenatal care (ANC) attendance. Here are the steps that can be taken to develop this recommendation into an innovation:

1. Strengthen ANC services: Enhance the quality and availability of ANC services in healthcare facilities across Burkina Faso. This can be achieved by training healthcare providers, ensuring the availability of necessary equipment and supplies, and improving the infrastructure of healthcare facilities.

2. Increase awareness and education: Implement community-based education programs to raise awareness about the importance of ANC and its impact on birth outcomes. This can involve conducting health campaigns, organizing workshops, and utilizing local media channels to disseminate information.

3. Overcome barriers to access: Identify and address the barriers that prevent pregnant women from attending ANC visits. These barriers may include distance to healthcare facilities, lack of transportation, financial constraints, cultural beliefs, and social norms. Introduce innovative solutions such as mobile clinics, telemedicine, or community health workers to reach remote areas.

4. Promote early and regular ANC attendance: Emphasize the significance of early and regular ANC visits to pregnant women and their families. Encourage women to seek ANC services as soon as they become aware of their pregnancy and to attend the recommended number of visits throughout their pregnancy.

5. Tailor ANC services to local needs: Take into account the cultural, social, and economic factors that influence ANC attendance in Burkina Faso. Adapt ANC services to meet the specific needs and preferences of the local population, ensuring that they are culturally sensitive and accessible to all.

6. Strengthen data collection and monitoring: Improve the collection and analysis of data related to ANC attendance and birth outcomes. This will help identify trends, measure the impact of interventions, and guide future improvements in maternal health services.

7. Collaborate with stakeholders: Foster partnerships between government agencies, healthcare providers, non-governmental organizations, and community leaders to collectively address the issue of low birthweight and improve access to maternal health. Pool resources, share best practices, and coordinate efforts to maximize impact.

By implementing these recommendations and continuously evaluating their effectiveness, it is possible to develop innovative solutions that improve access to maternal health and reduce the incidence of low birthweight in Burkina Faso.
AI Innovations Methodology
Based on the provided information, here are some potential recommendations to improve access to maternal health:

1. Strengthening Antenatal Care (ANC) Services: Enhance the availability and quality of ANC services by ensuring that pregnant women have access to regular check-ups, screenings, and health education. This can be achieved by increasing the number of healthcare facilities offering ANC services, training healthcare providers, and improving the availability of essential equipment and supplies.

2. Community-Based Interventions: Implement community-based interventions to increase awareness and utilization of ANC services. This can involve community health workers conducting outreach activities, organizing health education sessions, and providing transportation support for pregnant women to attend ANC visits.

3. Mobile Health (mHealth) Solutions: Utilize mobile technology to improve access to maternal health information and services. This can include mobile apps or text messaging platforms that provide educational resources, appointment reminders, and personalized health advice to pregnant women.

4. Financial Support: Implement policies or programs that provide financial support to pregnant women, particularly those from low-income backgrounds, to cover the costs associated with ANC visits, transportation, and other related expenses.

To simulate the impact of these recommendations on improving access to maternal health, a possible methodology could include the following steps:

1. Define the target population: Identify the specific population group or region where the recommendations will be implemented.

2. Collect baseline data: Gather data on the current state of access to maternal health services in the target population, including ANC attendance rates, birth outcomes, and other relevant indicators.

3. Develop a simulation model: Create a simulation model that incorporates the key variables and factors influencing access to maternal health. This model should consider factors such as population demographics, healthcare infrastructure, availability of resources, and the proposed interventions.

4. Input intervention scenarios: Define different scenarios based on the recommendations mentioned earlier. For each scenario, specify the expected changes in ANC attendance rates, birth outcomes, and other relevant indicators.

5. Run simulations: Use the simulation model to simulate the impact of each intervention scenario on improving access to maternal health. This can involve running multiple iterations of the model to account for variability and uncertainty.

6. Analyze results: Evaluate the simulation results to assess the potential impact of each intervention scenario on access to maternal health. Compare the outcomes of different scenarios to identify the most effective interventions.

7. Refine and validate the model: Continuously refine and validate the simulation model based on real-world data and feedback from stakeholders. This will help improve the accuracy and reliability of the simulations.

8. Communicate findings: Present the simulation results to relevant stakeholders, policymakers, and healthcare providers. Use the findings to advocate for the implementation of the most effective interventions and inform decision-making processes.

It is important to note that the methodology described above is a general framework and can be customized based on the specific context and available data.

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