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Assessing the impact of antenatal care utilization on low birthweight in India: Analysis of the 2015–2016 National Family Health Survey
... At the 65th World Health Assembly in 2012, nations pledged to reduce LBW by 30% from 2012 to 2025 [3]. Since the ANC services received by the mother during pregnancy and the health of the infant are related, high-quality antenatal care (ANC) is essential for lowering the prevalence of LBW [10][11][12]. These treatments focus on health maintenance, early identification, and prevention during pregnancy. ...
... Values are presented as adjusted odds ratio (95% confidence interval).LBW, low birth weight; ASEAN, Association of Southeast Asian Nations; ANC, antenatal care. [11,22,23]. These findings also demonstrated that the incidence of LBW in the four nations was unaffected by an ANC visit during the first trimester. ...
... These findings also demonstrated that the incidence of LBW in the four nations was unaffected by an ANC visit during the first trimester. However, Bhaskar et al. [24] in Eastern Nepal and Paul et al. [11] in India found conflicting results, finding that moms who had their first ANC check in the second or third trimester were more likely to have babies with LBW than mothers who had their first ANC visits in the first trimester. We anticipate that the significance of the initial ANC visit was significantly influenced by the fixed effect of the composite variable of the full coverage and substance of ANC services in this study. ...
Aim: This study aimed to see how the availability of comprehensive antenatal care (ANC) and its content affected the incidence of low birth weight (LBW) in four ASIAN member countries (ASIAN). Methods: The frequency of ANC visits and the seven service components were used as indicators of the comprehensiveness of coverage and substance of ANC services (blood pressure measurement, iron supplementation, tetanus toxoid immunization, explanations of pregnancy complications, urine sample test, blood sample test, and weight measurement). If more than four ANC visits and all seven components were provided, the coverage and content of the ANC services were rated as high. Using data from the four ASIAN nations in question from the Demographic Health Survey, multi-variable logistic regression with complicated survey designs was performed from 2014 to 2017. Results: Philippines (13.8%) had a greater percentage of LBW new-borns than Indonesia (6.7%), Cambodia (6.7%), or Myanmar (7.5%). A low level of comprehensive coverage and substance of ANC services was linked to a 1.30 times higher incidence of LBW than a high level (adjusted odds ratio [aOR], 1.30; 95% confidence interval [CI], 1.11 to 1.52). In addition, after accounting for mothers' demographic/socioeconomic characteristics, health habits, and other factors, the risk of LBW was higher in the Philippines than in other nations (aOR, 2.25; 95% CI, 2.01 to 2.51). Conclusion: In summary, the incidence of LBW in Indonesia, Cambodia, and Myanmar was substantially correlated with the comprehensive coverage and substance of ANC services. The Philippines had a greater risk of LBW with inadequate ANC but no statistically significant evidence for this connection.
... Countries committed to a 30% reduction in LBW between 2012 and 2025 at the 65th World Health Assembly in 2012 [3]. High-quality antenatal care (ANC) is key for reducing the incidence of LBW, as the ANC services obtained by the mother during pregnancy and the health of the newborn are correlated [10][11][12]. These services are related to prevention, early detection, and maintenance of good health during pregnancy. ...
... findings are consistent with previous results reported in the literature [11,22,23]. These results also showed that an ANC visit in the first trimester did not affect the incidence of LBW across the 4 countries. ...
... These results also showed that an ANC visit in the first trimester did not affect the incidence of LBW across the 4 countries. However, different results were reported by Bhaskar et al. [24] in Eastern Nepal and Paul et al. [11] in India, who found that mothers who made their first ANC visit in the second or third trimester were at a higher risk of giving birth to babies with LBW than mothers who underwent first ANC visits in the first trimester. We assume that the fixed effect of the composite variable of the complete coverage and content of ANC services in this study substantially influenced the significance of the first ANC visit. ...
Objectives:
This study aimed to assess the effect of complete coverage and content of available antenatal care (ANC) on the incidence of low birth weight (LBW) in 4 countries belonging to the Association of Southeast Asian Nations (ASEAN).
Methods:
Measures of complete coverage and content of ANC services included the frequency of ANC visits and the seven service components (blood pressure measurement, iron supplementation, tetanus toxoid immunization, explanations of pregnancy complications, urine sample test, blood sample test, and weight measurement). The complete coverage and content of ANC services were assessed as high if more than 4 ANC visits and all seven components were delivered. Multivariable logistic regression with complex survey designs was conducted using Demographic Health Survey data from the 4 ASEAN countries in question from 2014 to 2017.
Results:
The proportion of LBW infants was higher in the Philippines (13.8%) than in Indonesia (6.7%), Cambodia (6.7%), or Myanmar (7.5%). Poor ANC services were associated with a 1.30 times higher incidence of LBW than a high level of complete coverage and content of ANC services (adjusted odds ratio [aOR], 1.30; 95% confidence interval [CI], 1.11 to 1.52). In addition, the risk of LBW was higher in the Philippines than in other countries (aOR, 2.25; 95% CI, 2.01 to 2.51) after adjusting for mothers' demographic/socioeconomic factors, health behaviors, and other factors.
Conclusions:
In sum, complete coverage and content of ANC services were significantly associated with the incidence of LBW in Indonesia, Cambodia, and Myanmar. The Philippines did not show statistically significant results for this relationship, but had a higher risk of LBW with poor ANC.
... The physical growth and cognitive development of children are largely affected by mineral and trace element contents presents in mother's breast milk. Some studies showed that the trace elements and mineral contents were high in those mothers who are well-nourished compared to malnourished with Short gestation age and it is the outcome of less energy food intake during pregnancy (Kramer, 2003;Mane et al., 2018;Paul et al., 2019). Estimation also showed that various socio-economic factors such as household wealth status, parental education, place of residence also have a significant impact on U5M. ...
... The probability of U5M is significantly higher among those children whose size at birth were smaller than average or larger than average. Factors contributing to these findings could include the poor nutritional status of the mother, low birth weight, premature birth, lack of proper maternal ANC and PNC visits etc. (Dayanithi, 2018;Kalanda et al., 2009;Lau et al., 2013;Paul et al., 2019). Therefore, there is an urgent need for target-oriented policy intervention to improve maternal and child health as well as the socio-economic status of children's family that will help to reduce the complication during pregnancy, adverse birth outcomes including premature birth, LBW, etc. ...
The witnessing phenomena of under-five mortality (U5M) of children, in major South Indian states were below the national average (36.6 per 1000 live birth) as well as the global average (39 per 1000 live birth) but despite the policy implication to reduce the U5M, it persists still at a higher rate in North-Eastern states. The present paper aims to examine the association between Socio-economic; maternal, child-related risk factors and U5M of children in Empowered Action Group states and Assam of India. A cross-sectional data (n = 38,405) from National Family Health Survey (2015-2016) was used. The result of binary logistic regression model showed that the likelihood of U5M was significantly higher among those children whose family belonged to poor wealth status, lived in rural areas, and having parents with no education or very minimum education. The U5M of children also associated with having a younger mother, being perceived as small or large size & low birth weight of new-borns by their mother, with short birth interval, short-duration breastfeeding and low gestation age. The Findings of the study suggests that community-based interventions for women are needed to avert the phenomena of U5M in EAG states and Assam.
... In this study, frequency has a relationship with the incidence of LBW. The same study conducted by [12] LBW was significantly lower among children whose mothers had adequate ANC services among mothers who did not receive such services even after research results showed that mothers who had an ANC frequency <4 times reduced the percentage of LBW births [13]. ...
Purpose: Efforts to reduce low birth weight (LBW) cases can be made by regularly conducting antenatal care (ANC) during pregnancy. The aim is to improve the quality of ANCs and the quality of mothers, fetuses, and newborns associated with ANC. The World Health Organization (WHO) recommends reducing perinatal mortality and increasing the ability of care of pregnant women to make at least eight visits during pregnancy. This study aims to prove WHO's recommendation of at least 8 times the effect of ANC on LBW events in Indonesia. Methods: This study used a retrospective cohort and observational study design. The sample in this study were all women of childbearing age who were respondents to the 2017 IDHS. Data testing was performed using univariable, bivariable, and multivariable analysis. The analysis was performed by logistic regression. Results: ANC frequency was 8 times proven to reduce LBW risk; the lower the ANC contact, the greater the LBW risk. The incidence of LBW is lower in mothers who get quality ANC services. Exposure to cigarette smoke, the area of residence in Sulawesi, NTT, and NTB, and the distance of pregnancy affect the incidence of LBW without changing the relationship of the ANC frequency with LBW. Conclusions: Mothers who regularly perform pregnancy checks at least 8 times by the standards become protection for LBW.
... 52 A possible reason would be, increased maternal educational level improves ANC attendance, 65 which combats the incidence of low birth weight. 66 Moreover, low educational status may also lead to limited access to prenatal care, mainly in places where mothers are expected to pay for service and limits women from having independent decisions and good access to family resources which are very important for better nutrition. 67 This study indicated a significant difference among resident of mothers with regard to birth weight of a newborn baby. ...
... The most effective methods to prevent preterm birth depend on the obstetric history, which makes the identification of women at risk of preterm birth an important task for antenatal care providers [24]. Proper antenatal care coverage during pregnancy is also beneficial for preventing low birth weight in low and middle-income countries [25,26]. If a quality assessmentthrough continuous ANC is not established, resulting in a late initiation of ANC, insufficient visits, and incomplete examination, pregnant women may not receive adequate ANC at the appropriate time. ...
Background
Antenatal care (ANC) plays a crucial role in ensuring maternal and child safety and reducing adverse delivery outcomes. This study aimed to analyze the association between the quality of ANC and the occurrence of preterm birth and low birth weight in a sample of the population from 16 regions in 8 provinces in China.
Methods
Data from all closed cases of pregnant women and newborns reported in the Maternal and Child Health Monitoring System from January 1, 2018, to December 31, 2018, in 16 monitoring regions across 8 provinces in China were collected and included in the analysis, resulting in a total of 49,084 pregnant women and 49,026 newborns.
Results
The mean number of ANC visits was 6.95 ± 3.45. By percentage, 78.79% of the women received ANC examinations at least five times. The percentage of normative ANC examinations and the percentage of qualified ANC examinations was 30.98% and 8.0% respectively. The gestational age(χ² = 229.305, p<0.001), birth weight (χ² = 171.990, p<0.001) and the occurrence of neonatal complications (χ² = 53.112, p<0.001) were all significantly related to the number of ANC visits to mothers. There was a correlation between gestational age (χ² = 1021.362, p<0.001;χ² = 194.931, p<0.001) and birth weight (χ² = 259.009, p<0.001; χ² = 70.042, p<0.001) with normative ANC and qualified ANC examinations. As the number of ANC examinations increased, the rates of preterm birth and low birth weight decreased. Pregnant women who did not receive normative ANC examinations had a higher risk of preterm birth and neonatal low birth weight compared to those who did; Adjusted Odds Ratio (95%CI) was 23.33(16.97~32.07)and 1.61(1.37~1.90) respectively. Pregnant women who did not receive qualified ANC examinations had a higher risk of preterm birth and neonatal low birth weight compared to those who did; Adjusted Odds Ratio (95%CI) was 15.05(8.45~26.79)and 1.36 (1.02~1.82) respectively.
Conclusion
The percentage of women who received normative ANC examination and qualified ANC examination is still low in China, and the quality of antenatal care significantly affects the occurrence of preterm birth and low birth weight in newborns.
... ANC service recipients have significantly lower chances of having LBW children than other mothers, which is consistent with earlier studies. [17,28,29] Practice good health practices while pregnant and have regular exams of the mother and fetus to help prevent complications like LBW. [17] In this research, a significant relationship between a mother's education and LBW in both rounds was discovered. The prevalence of LBW babies in both rounds decreased with an increase in maternal education. ...
BACKGROUND: A serious global public health issue is low birth weight.
OBJECTIVE: This study used information from NFHS rounds 4 and 5 to gauge the shift in predominance of lower birth weight difference between the 2 rounds.
MATERIALS AND METHODS: Surveys on National Family Health from 2015–2016 (NFHS 4) and 2019–2021 (NFHS 5) were utilized to compile the data. This sample contained 2,09,266 under-5 children from NFHS-5 and 1,93,345 under-5 children from NFHS-4. Both bivariate and multivariate approaches were used for analysis.
RESULT: In India, the prevalence of LBW was marginally reduced from 17.6% to 17.4% although it was not substantial. In comparison to male children, the likelihood of LBW is greater in female children (OR: 1.22; CI: 1.19-1.26 and OR:1.22, CI: 1.19-1.26), whose mothers are underweight (OR: 1.29; CI: 1.25-1.34 and OR: 1.27; CI: 1.22-1.31), and in children whose mothers are under 20 years (OR: 1.15; CI: 1.09-1.22 and OR: 1.13; CI:1.06-1.19). First-born children (18.6% to 18.2%), mothers who do not smoke (17.9% to 17.5%), and those from the North (19.8% to 18.2%) and the South (16.8%
to 15.8%) experienced a drop in the prevalence of LBW.
CONCLUSION: There was no discernible difference between the average rate of low birth weight. To address the high frequency of LBW children, programmers, and policies will need to be developed. This research adds significant knowledge to the body of knowledge of the elements that affect LBW and are most closely tied to the mother.
... These findings were further confirmed by multivariate analyses that adjusted for clustering and selected covariates. Available studies on the relationship between birthweight and the quality of ANC services suggested a lower risk of LBW associated with high-quality ANC services [30][31][32][33][34][35][36][37][38]. However, most of these studies lack rigor due to their cross-sectional nature, and only a few utilized data from case-control designs. ...
... These findings were further confirmed by multivariate analyses that adjusted for clustering and selected covariates. Available studies on the relationship between birthweight and the quality of ANC services suggested a lower risk of LBW associated with high-quality ANC services [30][31][32][33][34][35][36][37][38]. However, most of these studies lack rigor due to their cross-sectional nature, and only a few utilized data from case-control designs. ...
Background
The Enhancing Nutrition and Antenatal Infection Treatment (ENAT) intervention was implemented in Ethiopia to improve newborn birth weight (BW) by strengthening the contents and quality of antenatal care (ANC), especially point-of-care testing for maternal infections. This study examined the effect of the ENAT intervention on birth weight.
Methods
We conducted a cluster randomized controlled trial of 22 clusters (health centers), randomized equally between 11 intervention and 11 control clusters. This study enrolled and followed pregnant women from ANC booking to the end of pregnancy or loss to follow-up. The primary outcome was mean BW, and the incidence of low birth weight (LBW) was the secondary outcome. We presented univariate comparisons of outcomes between the intervention and control arms for mean BW and LBW. Multilevel analyses using random effects models were performed to adjust for clustering and individual-level covariates.
Results
We enrolled and followed up 4,868 and 4,821 pregnant women in the intervention and control arms, respectively, from March 2021-July 2022. During follow-up, 3445 pregnant women in the intervention and 3192 in the control delivered in the health centers, and BW measurements of their babies were recorded within 48 h. The mean BW was 3,152 g (standard deviation (SD) = 339.8 g) in the intervention and 3,044 g (SD = 353.8 g) in the control arms (mean difference, 108 g; 95% confidence interval (CI): 91.3-124.6; P = 0.000). Adjusting for clustering and several covariates, the mean BW remained significantly higher in the intervention arm than in the control arm (adjusted ß coef., 114.3; p = 0.011). The incidence of LBW was 4.7% and 7.3% in the intervention and control arms, respectively. The adjusted risk of LBW was significantly lower by 36% in the intervention arm than in the control arm (adjusted relative risk, 0.645; p = 0.027).
Conclusion
This study provided sufficient evidence of the effectiveness of the ENAT intervention in improving birth weight in the study population. The intervention demonstrated that an increase in birth weight can be attained by availing point-of-care testing, strengthening infection prevention, and maternal nutrition within the ANC platform of public health facilities in a low-income setting.
Trial Registration
Registered at Pan African Clinical Trial Registry (PACTR) database dated 09/05/2023, https://pactr.samrc.ac.za/TrialDisplay.aspx?TrialID=25493. The unique identification number for the registry is PACTR202305694761480.
... Hence, direct comparison of our results with other studies is not warranted. However, many have studied the relationship between birthweight and the quality of ANC services and suggested a lower risk of LBW associated with high-quality ANC services [30][31][32][33][34][35][36][37][38]. Most of these studies, however, lack rigor due to their cross-sectional nature, and few relied on data from case-control designs. ...
Background
The Enhancing Nutrition and Antenatal Infection Treatment (ENAT) intervention was implemented in Ethiopia to improve newborn birth weight by strengthening the contents and quality of antenatal care (ANC), especially point-of-care testing for maternal infections. This study examined the effect of the ENAT intervention on birth weight.
... This might be due to education decreases teenage pregnancy which can be ended up with LBW [38], teenage mothers have two folds risk of LBW [38] because of their demand for a double set of nutrition needed in completing her growth [42]. Moreover, increased maternal education level improves ANC attendance [43,44], which combats the incidence of LBW [45]. ...
... A recently conducted study in India revealed that women who use contraceptives are more likely to attend ANC services [16]. In an agreement with previous studies [13,17], the present study affirmed that adequate utilization of ANC was associated with a decreased risk of LBW babies. Routine examination of the mother and fetus and practicing good health habits during pregnancy may help to reduce adverse pregnancy outcomes including LBW. ...
Objective
Low birth weight (LBW) is a serious public health problem in low- and middle-income countries and a leading cause of death in the first month of life. In India, about 18% of children are born with LBW (<2500 grams) in 2015–16. In this study, we aim to examine the influence of maternal factors and socio-demographic covariates on LBW in Indian children.
Methods
Data were drawn from the fourth round of the National Family Health Survey (NFHS-4), conducted in 2015–16. A cross-sectional study was designed using a stratified two-stage sampling technique. Cross-tabulation, Pearson’s chi-squared test, and multivariate logistic regression analyses were employed to assess the impact of maternal factors and other covariates on children’s LBW.
Results
Of total participants (n = 147,762), 17.5% of children were found to be born with LBW. The study revealed that women who had prior experience of stillbirth (Adjusted odds ratio [AOR]: 1.20, 95% CI: 1.04–1.38) and any sign of pregnancy complications (AOR: 1.08, 95% CI: 1.05–1.11) were more likely to have LBW children, even after adjusting for a range of covariates. Maternal food diversity was found to a protective factor against children’s LBW. Women with underweight and anemic condition were associated with an increased likelihood of LBW children. Regarding maternity care, women who attended ≥4 ANC visits (AOR: 0.84, 95% CI: 0.80–0.88), took iron tablets/syrup during pregnancy (AOR: 0.94, 95% CI: 0.90–0.98), and delivered in a public health facility (AOR: 0.84, 95% CI: 0.79–0.88) were less likely to have LBW babies. Besides, various socio-demographic factors such as place of residence, caste, religion, education, wealth quintile, and geographical region were significantly associated with LBW of children.
Conclusion
Interventions are needed for adequate ANC utilization, improvement in public facility-based delivery, providing iron supplementation, and uptake of balanced energy-protein diet among pregnant mothers. Besides, special attention should be given to the socio-economically disadvantaged women to address adverse pregnancy and birth outcomes including LBW.
... This finding is consistent with studies done in Ghana (36,37), India (38), Afghanistan (39),developing countries (17) and Cambodia (40). This might be due to education decreases teenage pregnancywhich can be ended up with LBW (37), teenage mothers have two folds risk of LBW (37)because of their demand for a double set of nutrition needed in completing her growth (41).Moreover, increased maternal education level improves ANC attendance (42,43),which combats the incidence of LBW (44). ...
... This finding is consistent with studies done in Ghana (36,37), India (38), Afghanistan (39),developing countries (17) and Cambodia (40). This might be due to education decreases teenage pregnancywhich can be ended up with LBW (37), teenage mothers have two folds risk of LBW (37)because of their demand for a double set of nutrition needed in completing her growth (41).Moreover, increased maternal education level improves ANC attendance (42,43),which combats the incidence of LBW (44). ...
Low birth weight (if birth weight of newborn baby is less than 2500 grams) is one of the burning public health issues. Globally, more than 20 million infants are born with low birth weight; mainly it is prevailing in South Asian countries, and an estimated 7.5 million are from India. Proper utilization of antenatal care (ANC) services during pregnancy can reduce the occurrence of low birth weight. The present study attempts to show the role of inadequate antenatal care services for occurrence of low birth weight among the Muslim women of Maldah district of West Bengal. The entire study was based on primary data collected from 1120 Muslim women who had at least one live birth with the help of structured questionnaire. The result shows that about 55% of the Muslim women did not receive the recommended (at least 4 ANC visits) antenatal visits during their pregnancy and 31% of the women delivered newborn baby having low birth weight which is responsible for higher infant mortality as well as maternal mortality. The bivariate and multivariable analysis shows that the occurrence of low birth weight is more among those women who had not received all the required antenatal care services during pregnancy.
In Central Java, the prevalence of LBW (Low Birth Weight) has increased from 4.3 (2018) to 4.7 (2019) and be the biggest cause of neonatal mortality (46.4%) and infant mortality (40.5%). The aim of this research is to analyze the relationship between quality of ANC (Antenatal Care), iron supplementation, pregnancy complications, and maternal smoking status with LBW in Central Java. This research was an analytical study used secondary data from the 2017 IDHS (Indonesian Demographic and Health Survey). The sampling design used purposive sampling.Population study was 1205 babies born in Central Java. The sample comprised 952 babies. Independent variables were the quality of ANC, iron supplementation, pregnancy complications, and maternal smoking status, with the incidence of LBW as dependent variable. Data analysis was performed by chi-square continuity correction and logistic regression. Pregnancy complications have been associated with the incidences of LBW in Central Java (p-value = 0.0001). Iron supplementation (OR = 2.474) and pregnancy complications (OR = 4.869) had an effect on the incidence of LBW in Central Java. Iron supplementation and pregnancy complications influenced the incidence of LBW in Central Java.
Objective
To identify the medical causes of death and contribution of non-biological factors towards infant mortality by a retrospective analysis of routinely collected data using verbal and social autopsy tools.
Setting
The study site was Health and Demographic Surveillance System (HDSS), Ballabgarh, North India
Participants
All infant deaths during the years 2008–2012 were included for verbal autopsy and infant deaths from July 2012 to December 2012 were included for social autopsy.
Outcome measures
Cause of death ascertained by a validated verbal autopsy tool and level of delay based on a three-delay model using the INDEPTH social autopsy tool were the main outcome measures. The level of delay was defined as follows: level 1, delay in identification of danger signs and decision making to seek care; level 2, delay in reaching a health facility from home; level 3, delay in getting healthcare at the health facility.
Results
The infant mortality rate during the study period was 46.5/1000 live births. Neonatal deaths contributed to 54.3% of infant deaths and 39% occurred on the first day of life. Birth asphyxia (31.5%) followed by low birth weight (LBW)/prematurity (26.5%) were the most common causes of neonatal death, while infection (57.8%) was the most common cause of post-neonatal death. Care-seeking was delayed among 50% of neonatal deaths and 41.2% of post-neonatal deaths. Delay at level 1 was most common and occurred in 32.4% of neonatal deaths and 29.4% of post-neonatal deaths. Deaths due to LBW/prematurity were mostly followed by delay at level 1.
Conclusion
A high proportion of preventable infant mortality still exists in an area which is under continuous health and demographic surveillance. There is a need to enhance home-based preventive care to enable the mother to identify and respond to danger signs. Verbal autopsy and social autopsy could be routinely done to guide policy interventions aimed at reduction of infant mortality.
Objectives: Low birth weight (LBW) is a major public health concern, especially in developing countries, and is frequently related to child morbidity and mortality. This study aimed to identify key determinants that influence the prevalence of LBW in selected developing countries.
Methods: Secondary data analysis was conducted using 10 recent Demography and Health Surveys from developing countries based on the availability of the required information for the years 2010 to 2013. Associations of demographic, socioeconomic, community-based, and individual factors of the mother with LBW in infants were evaluated using multivariate logistic regression analysis.
Results: The overall prevalence of LBW in the study countries was 15.9% (range, 9.0 to 35.1%). The following factors were shown to have a significant association with the risk of having an LBW infant in developing countries: maternal age of 35 to 49 years (adjusted odds ratio [aOR], 1.7; 95% confidence interval [CI], 1.2 to 3.1; p<0.01), inadequate antenatal care (ANC) (aOR, 1.7; 95% CI, 1.1 to 2.8; p<0.01), illiteracy (aOR, 1.5; 95% CI, 1.1 to 2.7; p<0.001), delayed conception (aOR, 1.8; 95% CI, 1.4 to 2.5; p<0.001), low body mass index (aOR, 1.6; 95% CI, 1.2 to 2.1; p<0.001) and being in the poorest socioeconomic stratum (aOR, 1.4; 95% CI, 1.1 to 1.8; p<0.001).
Conclusions: This study demonstrated that delayed conception, advanced maternal age, and inadequate ANC visits had independent effects on the prevalence of LBW. Strategies should be implemented based on these findings with the goal of developing policy options for improving the overall maternal health status in developing countries.
Due to the high number of maternal deaths, provision of antenatal care services (ANC) in Indonesia is one of the key aims of the post-Millennium Development Goals agenda. This study aimed to assess the key factors determining use of ANC by adolescent girls and young women in Indonesia. Data from the Indonesia Demographic and Health Survey 2012 were used, with a focus on married adolescent girls (aged 15–19 years, n = 543) and young women (20–24 years, n = 2,916) who were mothers. Bivariate and multiple logistic regression analyses were performed to determine the factors associated with ANC use. The findings indicated that adolescents were less likely to make ANC visits than young women. Richer women were more likely to make four ANC visits in both groups compared to the poorer women. Living in urban areas, higher educational attainment, and lower birth order were also all associated with higher levels of receiving ANC among young women. The results showed that socio-economic factors were related to the use of ANC among adolescent girls and young women. Ongoing health-care interventions should thus put a priority on adolescent mothers coming from poor socio-economic backgrounds.
The National Rural Health Mission (NRHM) has been a watershed in the history of India's health sector. As a previously unattempted investment, governance, and mobilization effort, the NRHM succeeded in injecting new energy into India's public health system. A huge expansion of infrastructure and human resources is the hallmark of the NRHM action. Demand-side initiatives led to enhanced utilization of public health facilities, especially for facility births. The impact is visible. The Mission has brought Millennium Development Goals 4 and 5 within India's grasp. Acceleration in infant and neonatal mortality reduction is especially notable. The NRHM has created conditions for the country to move toward universal health coverage.
Both young and advanced maternal age is associated with adverse birth and child outcomes. Few studies have examined these associations in low-income and middle-income countries (LMICs) and none have studied adult outcomes in the offspring. We aimed to examine both child and adult outcomes in five LMICs.
In this prospective study, we pooled data from COHORTS (Consortium for Health Orientated Research in Transitioning Societies)-a collaboration of five birth cohorts from LMICs (Brazil, Guatemala, India, the Philippines, and South Africa), in which mothers were recruited before or during pregnancy, and the children followed up to adulthood. We examined associations between maternal age and offspring birthweight, gestational age at birth, height-for-age and weight-for-height Z scores in childhood, attained schooling, and adult height, body composition (body-mass index, waist circumference, fat, and lean mass), and cardiometabolic risk factors (blood pressure and fasting plasma glucose concentration), along with binary variables derived from these. Analyses were unadjusted and adjusted for maternal socioeconomic status, height and parity, and breastfeeding duration.
We obtained data for 22 188 mothers from the five cohorts, enrolment into which took place at various times between 1969 and 1989. Data for maternal age and at least one outcome were available for 19 403 offspring (87%). In unadjusted analyses, younger (≤19 years) and older (≥35 years) maternal age were associated with lower birthweight, gestational age, child nutritional status, and schooling. After adjustment, associations with younger maternal age remained for low birthweight (odds ratio [OR] 1·18 (95% CI 1·02-1·36)], preterm birth (1·26 [1·03-1·53]), 2-year stunting (1·46 [1·25-1·70]), and failure to complete secondary schooling (1·38 [1·18-1·62]) compared with mothers aged 20-24 years. After adjustment, older maternal age remained associated with increased risk of preterm birth (OR 1·33 [95% CI 1·05-1·67]), but children of older mothers had less 2-year stunting (0·64 [0·54-0·77]) and failure to complete secondary schooling (0·59 [0·48-0·71]) than did those with mothers aged 20-24 years. Offspring of both younger and older mothers had higher adult fasting glucose concentrations (roughly 0·05 mmol/L).
Children of young mothers in LMICs are disadvantaged at birth and in childhood nutrition and schooling. Efforts to prevent early childbearing should be strengthened. After adjustment for confounders, children of older mothers have advantages in nutritional status and schooling. Extremes of maternal age could be associated with disturbed offspring glucose metabolism.
Wellcome Trust and the Bill & Melinda Gates Foundation.
Copyright © 2015 Fall et al. Open access article published under the terms of CC BY. Published by Elsevier Ltd.. All rights reserved.
This study aimed to investigate factors that influence antenatal care utilization and their association with adverse pregnancy outcomes (defined as low birth weight, stillbirth, preterm delivery or small for gestational age) among pregnant women in Kumasi. A quantitative cross-sectional study was conducted of 643 women aged 19–48 years who presented for delivery at selected public hospitals and private traditional birth attendants from July–November 2011. Participants’ information and factors influencing antenatal attendance were collected using a structured questionnaire and antenatal records. Associations between these factors and adverse pregnancy outcomes were assessed using chi-square and logistic regression.
Nineteen percent of the women experienced an adverse pregnancy outcome. For 49% of the women, cost influenced their antenatal attendance. Cost was associated with increased likelihood of a woman experiencing an adverse outcome (adjusted OR = 2.15; 95% CI = 1.16–3.99; p = 0.016). Also, women with >5 births had an increased likelihood of an adverse outcome compared with women with single deliveries (adjusted OR = 3.77; 95% CI = 1.50–9.53; p = 0.005). The prevalence of adverse outcomes was lower than previously reported (44.6 versus 19%). Cost and distance were associated with adverse outcomes after adjusting for confounders. Cost and distance could be minimized through a wider application of the Ghana National Health Insurance Scheme.
This paper examines the patterns and determinants of maternal health care utilization across different social settings in south India: in the states of Andhra Pradesh, Karnataka, Kerala and Tamil Nadu. Data from the National Family Health Survey (NFHS) carried out during 1992–93 across most states in India are used. Results show that utilization of maternal health care services is highest in Kerala followed by Tamil Nadu, Andhra Pradesh and Karnataka. Utilization
of maternal health care services is not only associated with a range of reproductive, socio-economic, cultural and
program factors but also with state and type of health service. The interstate differences in utilization could be partly due to variations in the implementation of maternal health care program as well as differences in availability and accessibility between the states. In the case of antenatal care, there was no significant rural–urban gap, thanks to the role played by the multipurpose health workers posted in the rural areas to provide maternal health care services. The findings of this study provide insights for planning and implementing appropriate maternal health service delivery programs in order to improve the health and well-being of both mother and child.
To assess the association between maternal education level and birth weight, considering the circumstances in which the excess use of technology in healthcare, as well as the scarcity of these resources, may result in similar outcomes.
A meta-analysis of cohort and cross-sectional studies was performed; the studies were selected by systematic review in the MEDLINE database using the following Key**words socioeconomic factors, infant, low birth weight, cohort studies, cross-sectional studies. The summary measures of effect were obtained by random effect model, and its results were obtained through forest plot graphs. The publication bias was assessed by Egger's test, and the Newcastle-Ottawa scale was used to assess study quality.
The initial search found 729 articles. Of these, 594 were excluded after reading the title and abstract; 21, after consensus meetings among the three reviewers; 102, after reading the full text; and three for not having the proper outcome. Of the nine final articles, 88.8% had quality ≥ six stars (Newcastle-Ottawa Scale), showing good quality studies. The heterogeneity of the articles was considered moderate. High maternal education showed a 33% protective effect against low birth weight, whereas medium degree of education showed no significant protection when compared to low maternal education.
The hypothesis of similarity between the extreme degrees of social distribution, translated by maternal education level in relation to the proportion of low birth weight, was not confirmed.
The concept of knowing what works in terms of reducing maternal mortality is complicated by a huge diversity of country contexts and of determinants of maternal health. Here we aim to show that, despite this complexity, only a few strategic choices need to be made to reduce maternal mortality. We begin by presenting the logic that informs our strategic choices. This logic suggests that implementation of an eff ective intrapartum-care strategy is an overwhelming priority. We also discuss the alternative confi gurations of such a strategy and, using the best available evidence, prioritise one strategy based on delivery in primary-level institutions (health centres), backed up by access to referral-level facilities. We then go on to discuss strategies that complement intrapartum care. We conclude by discussing the inexplicable hesitation in decision-making after nearly 20 years of safe motherhood programming: if the fi fth Millennium Development Goal is to be achieved, then what needs to be prioritised is obvious. Further delays in getting on with what works begs questions about the commitment of decision-makers to this goal. is a deceptively simple phrase, often used in international advocacy aiming to reduce the burden of maternal mortality in developing countries. Strategies that aff ect this burden have proved to be among the most successful eff orts to address a specifi c cluster of causes of death, with developed and some developing countries having reduced the risk of maternal death by 90-99%. The 1000 deaths per 100 000 livebirths or greater risk of maternal mortality seen in the past in developed countries and now in the poorest developing countries, has been reduced to as low as 10 per 100 000. Although falling short of eradication of maternal death, these impressive reductions are similar to the eff ectiveness of such undisputed public-health interventions as polio immunisation (95%) or oral contraception (97%). At the same time, however, the substantial obstacles in poor countries to achievement of the maternal mortality target of Millennium Development Goal (MDG) 5 are well acknowledged, 2,3
People in poor countries tend to have less access to health services than those in better-off countries, and within countries, the poor have less access to health services. This article documents disparities in access to health services in low- and middle-income countries (LMICs), using a framework incorporating quality, geographic accessibility, availability, financial accessibility, and acceptability of services. Whereas the poor in LMICs are consistently at a disadvantage in each of the dimensions of access and their determinants, this need not be the case. Many different approaches are shown to improve access to the poor, using targeted or universal approaches, engaging government, nongovernmental, or commercial organizations, and pursuing a wide variety of strategies to finance and organize services. Key ingredients of success include concerted efforts to reach the poor, engaging communities and disadvantaged people, encouraging local adaptation, and careful monitoring of effects on the poor. Yet governments in LMICs rarely focus on the poor in their policies or the implementation or monitoring of health service strategies. There are also new innovations in financing, delivery, and regulation of health services that hold promise for improving access to the poor, such as the use of health equity funds, conditional cash transfers, and coproduction and regulation of health services. The challenge remains to find ways to ensure that vulnerable populations have a say in how strategies are developed, implemented, and accounted for in ways that demonstrate improvements in access by the poor.
Low Birth Weight (LBW) is one of the major risk factor for death in early life. However, little is known about predictors of LBW in sub-Saharan Africa. Therefore, the aim of this study was to measure the incidence and determinants of LBW in a rural population of Ethiopia.
An observational cohort study on pregnant women was conducted from December 2009 to November 2010. During the study period 1295 live birth were registered and the weights of 956 children were measured within 24 hours after birth. Socio-demographic, economic, maternal and organizational factors were considered as a predicators of LBW, defined as birth weight below 2500g. Logistic regression was used to analyze the data, odds ratio (OR) and confidence intervals (CI) are reported.
The incidence of LBW was 28.3%. It is significantly associated with poverty [OR 2.1; 95% CI: 1.42, 3.05], maternal Mid Upper Arm Circumference (MUAC) less than 23 cm [OR 1.6; 95% CI: 1.19, 2.19], not attending ANC [OR 1.6; 95% CI: 1.12, 2.28], mother's experience of physical violence during pregnancy [OR 1.7; 95% CI: 1.12, 2.48], and longer time to walk to health facility [OR 1.6; 95% CI: 1.11, 2.40].
The incidence of LBW was high in Kersa. Babies born to women who were poor, undernourished, experienced physical violence during pregnancy and who had poor access to health services were more likely to be LBW in this part of the country. In this largely poor community where ANC coverage is low, to reduce the incidence of LBW, it is essential to improve access for maternal health care. The involvement of husbands and the community at large to seek collective action on LBW is essential.
This study explores the prevalence and factors associated with the utilization of maternal and child health care services among married adolescent women in India using the third round of the National Family Health Survey (2005-06). The findings suggest that the utilization of maternal and child health care services among adolescent women is far from satisfactory in India. A little over 10% of adolescent women utilized antenatal care, about 50% utilized safe delivery services and about 41% of the children of adolescent women received full immunization. Large differences by urban-rural residence, educational attainment, religion, economic status and region were evident. Both gross effect and fixed effect binary logit models yielded statistically significant socioeconomic and demographic factors. Women's education, wealth quintile and region are the most important determinants for the utilization of maternal and child health care services. Health care programmes should focus more on educating adolescents, providing financial support, creating awareness and counselling households with married adolescent women. Moreover, there should be substantial financial assistance for the provision of delivery and child care for married women below the age of 19 years.
Small birth size may be associated with increased risk of cardiovascular diseases (CVD), whereas large birth size may predict increased risk of obesity and some cancers. The net effect of birth size on long-term mortality has only been assessed in individual studies, with conflicting results.
The Meta-analyses of Observational Studies in Epidemiology (MOOSE) guidelines for conducting and reporting meta-analysis of observational studies were followed. We retrieved 22 studies that assessed the association between birthweight and adult mortality from all causes, CVD or cancer. The studies were systematically reviewed and those reporting hazard ratios (HRs) and 95% confidence intervals (95% CIs) per kilogram (kg) increase in birthweight were included in generic inverse variance meta-analyses.
For all-cause mortality, 36,834 deaths were included and the results showed a 6% lower risk (adjusted HR = 0.94, 95% CI: 0.92-0.97) per kg higher birthweight for men and women combined. For cardiovascular mortality, the corresponding inverse association was stronger (HR = 0.88, 95% CI: 0.85-0.91). For cancer mortality, HR per kg higher birthweight was 1.13 (95% CI: 1.07-1.19) for men and 1.04 (95% CI: 0.98-1.10) for women (P(interaction) = 0.03). Residual confounding could not be eliminated, but is unlikely to account for the main findings.
These results show an inverse but moderate association of birthweight with adult mortality from all-causes and a stronger inverse association with cardiovascular mortality. For men, higher birthweight was strongly associated with increased risk of cancer deaths. The findings suggest that birthweight can be a useful indicator of processes that influence long-term health.
In this review, the authors summarize current knowledge on maternal nutritional requirements during pregnancy, with a focus on the nutrients that have been most commonly investigated in association with birth outcomes. Data sourcing and extraction included searches of the primary resources establishing maternal nutrient requirements during pregnancy (e.g., Dietary Reference Intakes), and searches of Medline for "maternal nutrition"/[specific nutrient of interest] and "birth/pregnancy outcomes," focusing mainly on the less extensively reviewed evidence from observational studies of maternal dietary intake and birth outcomes. The authors used a conceptual framework which took both primary and secondary factors (e.g., baseline maternal nutritional status, socioeconomic status of the study populations, timing and methods of assessing maternal nutritional variables) into account when interpreting study findings. The authors conclude that maternal nutrition is a modifiable risk factor of public health importance that can be integrated into efforts to prevent adverse birth outcomes, particularly among economically developing/low-income populations.
In this paper we examine the role of mothers' nutritional status and socio-biological aspects in determining the birth weight of their most recent child.
We used data from the second Indian National Family Health Survey conducted in 1998-1999. Analysis is based on children born within 12 months prior to the survey date (N = 10,042). We used a subjective measure of the size of infant at birth as an indicator for birth weight and employed logistic regression to estimate the effect of BMI and other determinants on birth weight of children in India as a whole and for 17 states separately.
Results show that mothers' nutritional status is the most important determinant of newborn children's birth weight. Safe drinking water, use of antenatal care and iron deficient anaemia were also significant contributors to low birth weight. Mothers' BMI impact is more pervasive across India than the impact of other factors on birth weight.
The dimensions of women's autonomy and their relationship to maternal health care utilization were investigated in a probability sample of 300 women in Varanasi, India. We examined the determinants of women's autonomy in three areas: control over finances, decision-making power, and freedom of movement. After we control for age, education, household structure, and other factors, women with closer ties to natal kin were more likely to have greater autonomy in each of these three areas. Further analyses demonstrated that women with greater freedom of movement obtained higher levels of antenatal care and were more likely to use safe delivery care. The influence of women's autonomy on the use of health care appears to be as important as other known determinants such as education.
This paper examines the patterns and determinants of maternal health care utilization across different social settings in South India: in the states of Andhra Pradesh, Karnataka, Kerala and Tamil Nadu. Data from the National Family Health Survey (NFHS) carried out during 1992-93 across most states in India are used. Results show that utilization of maternal health care services is highest in Kerala followed by Tamil Nadu, Andhra Pradesh and Karnataka. Utilization of maternal health care services is not only associated with a range of reproductive, socio-economic, cultural and program factors but also with state and type of health service. The interstate differences in utilization could be partly due to variations in the implementation of maternal health care program as well as differences in availability and accessibility between the states. In the case of antenatal care, there was no significant rural-urban gap, thanks to the role played by the multipurpose health workers posted in the rural areas to provide maternal health care services. The findings of this study provide insights for planning and implementing appropriate maternal health service delivery programs in order to improve the health and well-being of both mother and child.
Neonatal mortality accounts for almost 40 per cent of under-five child mortality, globally. An understanding of the factors related to neonatal mortality is important to guide the development of focused and evidence-based health interventions to prevent neonatal deaths. This study aimed to identify the determinants of neonatal mortality in Indonesia, for a nationally representative sample of births from 1997 to 2002.
The data source for the analysis was the 2002-2003 Indonesia Demographic and Health Survey from which survival information of 15,952 singleton live-born infants born between 1997 and 2002 was examined. Multilevel logistic regression using a hierarchical approach was performed to analyze the factors associated with neonatal deaths, using community, socio-economic status and proximate determinants.
At the community level, the odds of neonatal death was significantly higher for infants from East Java (OR = 5.01, p = 0.00), and for North, Central and Southeast Sulawesi and Gorontalo combined (OR = 3.17, p = 0.03) compared to the lowest neonatal mortality regions of Bali, South Sulawesi and Jambi provinces. A progressive reduction in the odds was found as the percentage of deliveries assisted by trained delivery attendants in the cluster increased. The odds of neonatal death were higher for infants born to both mother and father who were employed (OR = 1.84, p = 0.00) and for infants born to father who were unemployed (OR = 2.99, p = 0.02). The odds were also higher for higher rank infants with a short birth interval (OR = 2.82, p = 0.00), male infants (OR = 1.49, p = 0.01), smaller than average-sized infants (OR = 2.80, p = 0.00), and infant's whose mother had a history of delivery complications (OR = 1.81, p = 0.00). Infants receiving any postnatal care were significantly protected from neonatal death (OR = 0.63, p = 0.03).
Public health interventions directed at reducing neonatal death should address community, household and individual level factors which significantly influence neonatal mortality in Indonesia. Low birth weight and short birth interval infants as well as perinatal health services factors, such as the availability of skilled birth attendance and postnatal care utilization should be taken into account when planning the interventions to reduce neonatal mortality in Indonesia.
Objective: In an effort to improve utilization of maternal health care services, age at marriage of girls has gain very little attention by the policy maker and programmer. Studies have indicated that child
marriage has serious negative consequences on maternal health. Moreover, there is a paucity of research
on explaining the links between child marriage and maternal health care utilization. In this study, we
aimed to examine the association between child marriage and utilization of maternal health care services
using nationally representative sample survey of India.
Design: Cross-sectional observational study.
Setting: India.
Participants: A total number of 190,898 ever-married women who had at least one live birth during the
last five years preceding the survey from the 2015 to 2016 National Family Health Survey (NFHS) were
utilized.
Measurements: Outcome measures: At least four antenatal visits (ANC), ANC visit within first trimester,
institutional delivery, delivery by skilled health personnel, and postnatal care (PNC) within 42 days of
delivery. Predictor variable: Child marriage. Control variables: Socio-economic and demographic characteristics
of women. Bivariate and multivariate analyses were performed for the analyses of the study data.
Results: The results of our study revealed that women who married at < 18 years were significantly less
likely to use maternal health care services than those married at ≥18 years even after accounting for
socio-economic and demographic characteristics of women. Furthermore, nuanced analysis revealed that
the odds of maternity care services is much lower for those women who married at ≤14 years compared
with later married groups.
Conclusions: The findings of our study suggest that effort s should be made to increase age at marriage of girls which could have positive impact on utilization of maternal health care services. Moreover, targeted intervention is needed to improve the utilization of maternity care especially among socio-economically
vulnerable women.
Introduction: India along with Nigeria is estimated to account for over 1/3rd of all maternal deaths worldwide in the year 2015. However, among all the maternal deaths, most of the deaths can be prevented. But for that all women need access to antenatal care (ANC) during pregnancy. Objective: The present study aims to highlight the current status of ANC coverage in India. Further this study examines the extent of expenditure incurred for seeking ANC. Materials and methods: Data for the analyses are drawn from the 71st round of the National Sample Survey Office conducted between January to June 2014. Bivariate and logistic regression analyses have been used to fulfil the objectives of this paper. Results: Despite having a vast public health infrastructure and several safe motherhood programmes, overall 9.2% pregnant women did not consume IFA supplements, 6.6% did not receive TT dose and 10.3% pregnant women could not receive any ANC during pregnancy in India. Among the states, Uttar Pradesh accounted for a large number (16.7%) of pregnant women who neither did consume IFA tablets nor received any ANC (22.4%) during pregnancy. However, a woman had to spend a large amount of money to seek ANC from both public and private health care facilities. Conclusion: After a tremendous emphasis given to delivery of free ANC services throughout the country, India is still very far from achieving universal coverage of ANC.
Despite India's impressive economic performance after the introduction of economic reforms in the 1990s, progress in advancing the health status of Indians has been slow and uneven. Large inequities in health and access to health services continue to persist and have even widened across states, between rural and urban areas, and within communities. Three forms of inequities have dominated India's health sector. Historical inequities that have their roots in the policies and practices of British colonial India, many of which continued to be pursued well after independence; socio-economic inequities manifest in caste, class and. gender'differentials; and inequities in the availability, utilisation and affordability of health services. Of these, critical to ensuring health for all in the immediate future will be the effectiveness with which India addresses inequities in provisioning of health services and assurance of quality care.
The nutritional status of a woman before and during pregnancy is important for a healthy pregnancy outcome. Maternal malnutrition is a key contributor to poor fetal growth, low birthweight (LBW) and short- and long-term infant morbidity and mortality. This review summarised the evidence on association of maternal nutrition with birth outcomes along with review of effects of balanced protein-energy supplementation during pregnancy. A literature search was conducted on PubMed, WHOLIS, PAHO and Cochrane library. Only intervention studies were considered for inclusion and data were combined by meta-analyses if available from more than one study. Sixteen intervention studies were included in the review. Pooled analysis showed a positive impact of balanced protein-energy supplementation on birthweight compared with control [mean difference 73 (g) [95% confidence interval (CI) 30, 117]]. This effect was more pronounced in undernourished women compared with adequately nourished women. Combined data from five studies showed a reduction of 32% in the risk of LBW in the intervention group compared with control [relative risk (RR) 0.68 [95% CI 0.51, 0.92]]. There was a reduction of 34% in the risk of small-for-gestational-age babies in the intervention compared with the control group [RR 0.66 [95% CI 0.49, 0.89]]. The risk of stillbirth was also reduced by 38% in the intervention group compared with control [RR 0.62 [95% CI 0.40, 0.98]]. In conclusion, balanced protein-energy supplementation is an effective intervention to reduce the prevalence of LBW and small-for-gestational-age births, especially in undernourished women.
An ongoing social catastrophe of very poor performance in maternal health coupled with an unacceptably high number of maternal deaths is evident in Nigeria, especially among adolescent women. This study examines the factors associated with selected maternity services-married adolescent women who have had at least four antenatal care (ANC) visits, those who have undergone safe delivery care, and those who received postnatal care within 42 days of delivery.
Data from Nigeria Demographic and Health Survey, 2008, were used. An eligible sample of 2,434 married adolescent (aged 15-19 years) women was included in the analysis. Pearson chi-square test and binary logistic regression were performed to fulfill the study objective.
It was found that about 35% of adolescent women had at least four ANC visits, a little over 25% had undergone safe delivery care, and nearly 32% received postnatal care within 42 days of delivery. Women's education, husband's education, wealth quintile, and region of residence were documented as the most important factors associated with maternal healthcare service utilization. The ANC visit was found to be vital in the utilization of safe delivery and postnatal care.
Findings indicate that programs to improve maternal healthcare have not succeeded in overcoming the socioeconomic obstacles in the way of adolescents' utilizing maternity services. In the long run, the content and service delivery strategy of maternity programs must be designed in keeping with the socioeconomic context with special attention to adolescent women who are uneducated, poor, and residing in rural areas.
In India, despite improvements in access to health care, inequalities are related to socioeconomic status, geography, and gender, and are compounded by high out-of-pocket expenditures, with more than three-quarters of the increasing financial burden of health care being met by households. Health-care expenditures exacerbate poverty, with about 39 million additional people falling into poverty every year as a result of such expenditures. We identify key challenges for the achievement of equity in service provision, and equity in financing and financial risk protection in India. These challenges include an imbalance in resource allocation, inadequate physical access to high-quality health services and human resources for health, high out-of-pocket health expenditures, inflation in health spending, and behavioural factors that affect the demand for appropriate health care. Use of equity metrics in monitoring, assessment, and strategic planning; investment in development of a rigorous knowledge base of health-systems research; development of a refined equity-focused process of deliberative decision making in health reform; and redefinition of the specific responsibilities and accountabilities of key actors are needed to try to achieve equity in health care in India. The implementation of these principles with strengthened public health and primary-care services will help to ensure a more equitable health care for India's population.
A combined measure of optimal antenatal care can provide more information on the role it plays in maternal health. Our objectives were to investigate the determinants of a measure of optimal antenatal care and the associated pregnancy outcomes. Data on 7,557 women taken from the 2004 Demographic and Health Survey in Cameroon were used to develop a new measurement of optimal antenatal care based on four indicators: at least four visits, first visit in first trimester, last visit in third trimester and a professional provider of antenatal care. We studied the relationship of this new variable with other related variables in a multivariate analysis, taking into account the complex study design. Almost sixty six percent of the women had optimal antenatal care. Secondary or higher education (OR 1.74; 95% CI 1.28-2.36), greater wealth (OR 2.31; 95% CI 1.73-3.1), urban residence (OR 1.42; 95% CI 1.12-1.82) and parity of 3-4 (OR 0.79; 95% CI 0.62-0.99) were independently associated with optimal antenatal care. Women with optimal antenatal care were more likely to deliver in a health unit (OR 2.91; 95% CI 2.42-3.49), to be assisted by a skilled health worker during delivery (OR 1.88; 95% CI 1.49-2.37) and to have a baby with a normal birthweight (OR 1.62; 95% CI 1.11-2.38). Obtaining and using a new measure for ANC is feasible. The association of optimal antenatal care to education, wealth and residence in this study, consistent with others, highlights the role of the country's development in maternal health.
Studies in low-income countries have shown that women's autonomy (i.e. the freedom of women to exercise their judgment in order to act for their own interests) influences a number of reproductive and child health outcomes, including the use of pregnancy care services. However, studies have not examined the full spectrum of pregnancy care services needed for safe motherhood and have not accounted for community context. This study analyzed data on women and their villages from the cross-sectional population-based National Family Health Survey-2 (1998-1999) of rural India to investigate whether women's autonomy (measured in the 3 dimensions of decision-making autonomy, permission to go out, and financial autonomy) was associated with the use of adequate prenatal, delivery and postnatal care. The findings indicate women's autonomy was associated with greater use of pregnancy care services, particularly prenatal and postnatal care. The effect of women's autonomy on pregnancy care use varied according to the region of India examined (North, East and South) such that it was most consistently associated with pregnancy care use in south India, which also had the highest level of self-reported women's autonomy. The results regarding village level factors suggest that public investment in rural economic development, primary health care access, social cohesion and basic infrastructure such as electrification and paved roads were associated with pregnancy care use. Improvements in women's autonomy and these village factors may improve healthier child bearing in rural India.
It is generally recognized that low birth weight can be caused by many factors. Because many questions remain, however, about which factors exert independent causal effects, as well as magnitude of these effects, a critical assessment and meta-analysis of the English and French language medical literature published from 1970 to 1984 were carried out. The assessment was restricted to singleton pregnacies of women who lived at sea level and who had no chronic illnesses. Extremely rare factors were also excluded, as were complications of pregnancy. In this way, 43 potential determinants were identified. A set of a priori methodological standards were established for each potential determinant. Studies that satisfactorily met (SM) or partially met (PM) these standards were used to assess the existence and magnitude of an independent causal effect on birth weight, gestational age, prematurity, and intrauterine growth retardation (IUGR). A total of 921 relevant publications were identified, of whihc 895 were successfully located and reviewed. Factors with well-established direct causal impacts on intrauterine growth include infant sex, racial/ethnic origin, maternal height, pre-pregnancy weight, paternal weight and height, maternal birth weight, parity, history or prior low-birth-weight infants, gestational weight gain and caloric intake, general morbidity and episodic illness, malaria, cigarette smoking, alcohol consumption, and tobacco chewing. In developing countries, the major determinants of IUGR are Black or Indian racial origin, poor gestational nutrition, low pre-pregnancy weight, short maternal stature, and malaria. In developed countries, the most important single factor, by far, is cigarette smoking, followed by poor gestational nutrition and low pre-pregnancy weight. For gestational duration, only pre-pregnancy weight, prior history of premature or spontaneous abortion, in utero exposure to diethylstilbestrol, and cigarette smoking have well-established causal effects, and the majority of prematurity occurring in both developing and developed country settings remains unexplained. Modifiable factors with large effects on intrauterine growth or gestational duration should be targeted for public health intervention in the two settings, with an emphasis on IUGR in developing countries and prematurity in developed countries. Future research should focus on factors of potential quantitative importance for which data are either unavailable or inconclusive. In developing countries, the most important of these for intrauterine growth are caloric expenditure (maternal work), antenatal care, and certain vitamins and trace elements. For prematurity, especially in developed countries, factors deserving further study include genital tract infection, antenatal care, maternal employment and physical activity, and stress and anxiety.
Over ninety low-weight infants were born per thousand live births in South Carolina, based on 96,000 birth records from 1975 and 1979. Higher incidence of low birth weight for black infants cannot be explained away as a result of black/white differences in age or education of mothers, prenatal care, parity or length of birth intervals. Though all these factors are important predictors of birth weight, an increasing propensity to have low-weight babies persists among black mothers even after all these factors are controlled.
Domestic violence is increasingly recognized as a potentially modifiable risk factor for adverse pregnancy outcomes. This study was conducted to evaluate the relationship between abuse during pregnancy or within the last year and low birth weight and preterm birth.
From 1997 to 2001, 3149 low income, relatively low-risk pregnant women (82% African-American) participated in this prospective study. The Abuse Assessment Screen, a validated screening tool, which assesses emotional, physical or sexual abuse, injuries due to physical abuse and physical abuse in the index pregnancy, was filled out by 3103 women.
Of the women screened, 26.6% reported emotional abuse, 18.7% reported physical abuse in the past year and 10.3% women reported being beaten, bruised, threatened with a weapon or being permanently injured. Abuse during pregnancy was reported by 5.9% of the women. Low birth weight and preterm birth occurred in 10.9% and 10.2% of the pregnant women, respectively. Logistic regression analyzes indicated that injury due to physical abuse within the past year was significantly associated with both preterm birth [adjusted odds ratio (AOR) = 1.6, 95% confidence interval (CI) = 1.1-2.3] and low birth weight (AOR = 1.8, 95% CI = 1.3-2.5) after adjusting for other covariates. The mean birth weight of infants born to women who were injured due to physical abuse was significantly lower (-75.2 g, p = 0.04) than the mean birth weight of infants of women who were not injured.
These results indicate that in our population, injuries resulting from physical abuse are associated with both low birth weight and preterm birth.
The objectives of this paper are to examine factors associated with use of antenatal care in rural areas of north India, to investigate access to specific critical components of care and to study differences in the pattern of services received via health facilities versus home visits. We used the 1998-1999 Indian National Family Health Survey of ever-married women in the reproductive age group and analysed data from the states of Bihar, Madhya Pradesh, Rajasthan, and Uttar Pradesh (n = 11,369). Overall, about three-fifths of rural women did not receive any antenatal check-up during their last pregnancy. Services actually received were predominantly provision of tetanus toxoid vaccination and supply of iron and folic acid tablets. Only about 13% of pregnant women had their blood pressure checked and a blood test done at least once. Women visited by health workers received fewer services compared to women who visited a health facility. Home visits were biased towards households with a better standard of living. There was significant under-utilisation of nurse/midwives in the provision of antenatal services and doctors were often the lead providers. The average number of antenatal visits reported in this study was 2.4 and most visits were in the second trimester. Higher social and economic status was associated with increased chances of receiving an antenatal check-up, and of receiving specific components including blood pressure measurement, a blood test and urine testing but not the obstetric physical examination, which was however linked to ever-use of family planning and the education of women and their husbands. Thus, pregnant women from poor and uneducated backgrounds with at least one child were the least likely to receive antenatal check-ups and services in the four large north Indian states. Basic antenatal care components are effective means to prevent a range of pregnancy complications and reduce maternal mortality. The findings indicate substantial limitations of the health services in overcoming socio-economic and cultural barriers to access.
The proportion of child deaths that occurs in the neonatal period (38% in 2000) is increasing, and the Millennium Development Goal for child survival cannot be met without substantial reductions in neonatal mortality. Every year an estimated 4 million babies die in the first 4 weeks of life (the neonatal period). A similar number are stillborn, and 0.5 million mothers die from pregnancy-related causes. Three-quarters of neonatal deaths happen in the first week--the highest risk of death is on the first day of life. Almost all (99%) neonatal deaths arise in low-income and middle-income countries, yet most epidemiological and other research focuses on the 1% of deaths in rich countries. The highest numbers of neonatal deaths are in south-central Asian countries and the highest rates are generally in sub-Saharan Africa. The countries in these regions (with some exceptions) have made little progress in reducing such deaths in the past 10-15 years. Globally, the main direct causes of neonatal death are estimated to be preterm birth (28%), severe infections (26%), and asphyxia (23%). Neonatal tetanus accounts for a smaller proportion of deaths (7%), but is easily preventable. Low birthweight is an important indirect cause of death. Maternal complications in labour carry a high risk of neonatal death, and poverty is strongly associated with an increased risk. Preventing deaths in newborn babies has not been a focus of child survival or safe motherhood programmes. While we neglect these challenges, 450 newborn children die every hour, mainly from preventable causes, which is unconscionable in the 21st century.
The concept of knowing what works in terms of reducing maternal mortality is complicated by a huge diversity of country contexts and of determinants of maternal health. Here we aim to show that, despite this complexity, only a few strategic choices need to be made to reduce maternal mortality. We begin by presenting the logic that informs our strategic choices. This logic suggests that implementation of an effective intrapartum-care strategy is an overwhelming priority. We also discuss the alternative configurations of such a strategy and, using the best available evidence, prioritise one strategy based on delivery in primary-level institutions (health centres), backed up by access to referral-level facilities. We then go on to discuss strategies that complement intrapartum care. We conclude by discussing the inexplicable hesitation in decision-making after nearly 20 years of safe motherhood programming: if the fifth Millennium Development Goal is to be achieved, then what needs to be prioritised is obvious. Further delays in getting on with what works begs questions about the commitment of decision-makers to this goal.
Previous studies have found that inadequate prenatal care was associated with increased neonatal mortality in the general pregnant women.
To examine the association between adequacy of prenatal care and neonatal mortality in the presence and absence of antenatal high-risk conditions.
We conducted a retrospective cohort study of infants based on 1995-2000 vital statistics data in the USA. The relative risk for neonatal death associated with adequacy of prenatal care was estimated by multivariate logistic regressions with adjustment of confounding factors.
Inadequate prenatal care was associated with increased neonatal mortality when pregnancies were complicated by anaemia, cardiac disease, lung disease, chronic hypertension, diabetes, renal disease, pregnancy-induced hypertension, and previous preterm/small-for-gestational-age birth. The observed association also existed in the absence of these antenatal high-risk conditions. Overutilisation of prenatal care was associated with increased risk of neonatal deaths in both the presence and the absence of antenatal high-risk conditions. When gestational age at delivery and birthweight were further adjusted, the observed association between inadequate prenatal care and neonatal mortality was not significant in pregnancies with various high-risk conditions.
Inadequate prenatal care is associated with increased neonatal death in both the presence and the absence of antenatal high-risk conditions. The observed association between inadequate prenatal care and neonatal mortality may be mediated by increased risk of preterm delivery and low birthweight in these pregnancies. Overutilisation of prenatal care is associated with potential risks for fetal and neonatal development, leading to increased neonatal mortality.
This paper is a report of a systematic review to identify and analyse the main factors affecting the utilization of antenatal care in developing countries.
Antenatal care is a key strategy for reducing maternal mortality, but millions of women in developing countries do not receive it.
A range of electronic databases was searched for studies conducted in developing countries and published between 1990 and 2006. English-language publications were searched using relevant keywords, and reference lists were hand-searched.
A systematic review was carried out and both quantitative and qualitative studies were included.
Twenty-eight papers were included in the review. Studies most commonly identified the following factors affecting antenatal care uptake: maternal education, husband's education, marital status, availability, cost, household income, women's employment, media exposure and having a history of obstetric complications. Cultural beliefs and ideas about pregnancy also had an influence on antenatal care use. Parity had a statistically significant negative effect on adequate attendance. Whilst women of higher parity tend to use antenatal care less, there is interaction with women's age and religion. Only one study examined the effect of the quality of antenatal services on utilization. None identified an association between the utilization of such services and satisfaction with them.
More qualitative research is required to explore the effect of women's satisfaction, autonomy and gender role in the decision-making process. Adequate utilization of antenatal care cannot be achieved merely by establishing health centres; women's overall (social, political and economic) status needs to be considered.
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