Abstract
BackgroundMost maternal health programs in low- and middle- income countries estimate gestational age to provide appropriate antenatal care at the correct times throughout the pregnancy. Although various gestational dating methods have been validated in research studies, the performance of these methods has not been evaluated on a larger scale, such as within health systems. The objective of this research was to investigate the magnitude and impact of errors in estimated delivery dates on health facility delivery among women enrolled in a maternal health program in Zanzibar.MethodsThis study included 4225 women who were enrolled in the Safer Deliveries program and delivered before May 31, 2017. The exposure of interest was error in estimated delivery date categorized as: severe overestimate, when estimated delivery date (EDD) was 36 days or more after the actual delivery date (ADD); moderate overestimate, when EDD was 15 to 35 days after ADD; accurate, when EDD was 6 days before to 14 days after ADD; and underestimate, when EDD was 7 days or more before ADD. We used Chi-squared tests to identify factors associated with errors in estimated delivery dates. We performed logistic regression to assess the impact of errors in estimated delivery dates on health facility delivery adjusting for age, district of residence, HIV status, and occurrence of past home delivery.ResultsIn our data, 28% of the estimated delivery dates were a severe overestimate, 23% moderate overestimate, 41% accurate, and 8% underestimate. Compared to women with an accurate delivery date, women with a moderate or severe overestimate were significantly less likely to deliver in a health facility (OR = 0.71, 95% CI: [0.59, 0.86]; OR = 0.74, 95% CI: [0.61, 0.91]). When adjusting for multiple confounders, women with moderate overestimates were significantly less likely to deliver in a health facility (AOR = 0.76, 95% CI: [0.61, 0.93]); the result moved slightly towards null for women with severe overestimates (AOR = 0.84, 95% CI: [0.69, 1.03]).ConclusionsThe overestimation of women’s EDDs reduces the likelihood of health facility delivery. To address this, maternal health programs should improve estimation of EDD or attempt to curb the effect of these errors within their programs.
Highlights
Most maternal health programs in low- and middle- income countries estimate gestational age to provide appropriate antenatal care at the correct times throughout the pregnancy
As programs increasingly rely on community health workers (CHWs) to visit women throughout their pregnancy to promote health-seeking behaviors, identify danger signs, and encourage health facility delivery [5,6,7,8], these Community health worker (CHW) must have a reliable estimate of the delivery date to time these home visits and provide care tailored to the stage of pregnancy
In the Safer Deliveries data, if we classified term of the neonate based on the date of birth relative to the estimated delivery date, 42% of births would be classified as preterm (< 37 weeks), 50% term (37–40 weeks), Fig. 1 Distribution of gestational age by last menstrual period (LMP) at delivery in the Safer Deliveries program by birth term categorization and 8% late or post-term (> 41 weeks)
Summary
Most maternal health programs in low- and middle- income countries estimate gestational age to provide appropriate antenatal care at the correct times throughout the pregnancy. An abundance of recent research has assessed the accuracy of various gestational age measurement tools, most commonly comparing estimated delivery dates (EDD) based on last menstrual period (LMP) to dating by ultrasound [1, 9,10,11,12,13]. These studies show that both methods are subject to both random and systematic error. Due to differences in study designs and populations, these distributions are not directly comparable, but provide a range of plausible birth distributions from LMP measurements covering a variety of settings
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