Abstract
Background: Antenatal care (ANC) in many low- and middle-income countries is under-utilized and of sub-optimal quality. Group ANC (G-ANC) is an intervention designed to improve the experience and provision of ANC for groups of women (cohorts) at similar stages of pregnancy. Methods: A two-arm, two-phase, cluster randomized controlled trial (cRCT) (non-blinded) is being conducted in Kenya and Nigeria. Public health facilities were matched and randomized to either standard individual ANC (control) or G-ANC (intervention) prior to enrollment. Participants include pregnant women attending first ANC at gestational age <24 weeks, health care providers, and sub-national health managers. Enrollment ended in June 2017 for both countries. In the intervention arm, pregnant women are assigned to cohorts at first ANC visit and receive subsequent care together during five meetings facilitated by a health care provider (Phase 1). After birth, the same cohorts meet four times over 12 months with their babies (Phase 2). Data collection was performed through surveys, clinical data extraction, focus group discussions, and in-depth interviews. Phase 1 data collection ended in January 2018 and Phase 2 concludes in November 2018. Intention-to-treat analysis will be used to evaluate primary outcomes for Phases 1 and 2: health facility delivery and use of a modern method of family planning at 12 months postpartum, respectively. Data analysis and reporting of results will be consistent with norms for cRCTs. General estimating equation models that account for clustering will be employed for primary outcome analyzes. Results: Overall 1,075 and 1,013 pregnant women were enrolled in Nigeria and Kenya, respectively. Final study results will be available in February 2019. Conclusions: This is the first cRCT on G-ANC in Africa. It is among the first to examine the effects of continuing group care through the first year postpartum. Registration: Pan African Clinical Trials Registry PACTR201706002254227 May 02, 2017.
Highlights
Antenatal care (ANC) in many low- and middle-income countries is under-utilized and of sub-optimal quality
Through ANC, health care providers can identify emergent complications of pregnancy, but ANC serves as a primary health care platform for identification of underlying chronic health issues and support for healthy behaviors and preventive measures, such as oral iron supplementation, use of long-lasting insecticidal nets (LLIN), tetanus immunization, and counseling for postpartum family planning (PPFP)[2]
Both multiple ANC visits and high-quality ANC contacts are positively associated with facility delivery and skilled birth attendance[3,4,5]
Summary
Antenatal care (ANC) in many low- and middle-income countries is under-utilized and of sub-optimal quality. Pregnant women are assigned to cohorts at first ANC visit and receive subsequent care together during five meetings facilitated by a health care provider (Phase 1). Intention-to-treat analysis will be used to evaluate primary outcomes for Phases 1 and 2: health facility delivery and use of a modern method of family planning at 12 months postpartum, respectively. ANC often serves as an entry point for further interaction with the health system Both multiple ANC visits and high-quality ANC contacts are positively associated with facility delivery and skilled birth attendance[3,4,5]. Health care providers face numerous barriers to providing high-quality ANC (e.g., poorly resourced work environments, heavy workloads, long working hours), which cause stress, poor job satisfaction, and uncaring behavior toward clients[20,21]
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