Abstract
BackgroundLow quality and frequency of antenatal care (ANC) are associated with lower uptake of facility-based deliveries—a key intervention to reduce maternal and neonatal mortality. We implemented group ANC (G-ANC), an alternative service delivery model, in Kenya and Nigeria, to assess its impact on quality and attendance at ANC and uptake of facility-based delivery.MethodsFrom October 2016‒January 2018, we conducted a facility-based, pragmatic, cluster-randomized controlled trial with 20 clusters per country. We recruited women <24 weeks gestation during their first ANC visit and enrolled women at intervention facilities who agreed to attend G-ANC in lieu of routine individual ANC. The G-ANC model consisted of five monthly 2-hour meetings with clinical assessments alongside structured gestationally specific group discussions and activities. Quality of care was defined as receipt of eight specific ANC interventions. Data were obtained through facility records and self-report during a home-based postpartum survey. Analysis was by intention to treat.FindingsAll women who completed follow up are included in the analysis (Nigeria: 1018/1075 enrolled women [94.7%], Kenya: 826/1013 [81.5%]). In Nigeria women in the intervention arm were more likely to have a facility-based delivery compared to those in the control arm (Nigeria: 76.7% [391/510] versus 54.1% [275/508]; aOR 2.30, CI 1.51–3.49). In both countries women in the intervention arm were more likely than those in the control arm to receive quality ANC (Nigeria: aOR 5.8, CI 1.98–17.21, p<0.001; Kenya: aOR 5.08, CI 2.31–11.16, p<0.001) and to attend at least four ANC visits (Nigeria: aOR 13.30, CI 7.69–22.99, p<0.001; Kenya: aOR 7.12, CI 3.91–12.97, p<0.001).ConclusionsG-ANC was associated with higher facility-based delivery rates in Nigeria, where those rates associated with individual ANC were low. In both Kenya and Nigeria it was associated with a higher proportion of women receiving quality ANC and higher frequency of ANC visits.
Highlights
As evidenced in the Sustainable Development Goals [1], ending preventable maternal and neonatal mortality remain global priorities, as do improvements in the overall health and wellbeing of women and children [2]
G-antenatal care (ANC) was associated with higher facility-based delivery rates in Nigeria, where those rates associated with individual ANC were low
In both Kenya and Nigeria it was associated with a higher proportion of women receiving quality ANC and higher frequency of ANC visits
Summary
As evidenced in the Sustainable Development Goals [1], ending preventable maternal and neonatal mortality remain global priorities, as do improvements in the overall health and wellbeing of women and children [2]. Given over 40% of maternal and neonatal deaths occur in the first 24 hours after birth [3], mortality reduction strategies often emphasize skilled intrapartum care and facility-based delivery, still lacking for nearly 31 million births in 2016 [4]. Evidence suggests both the number and quality of antental care (ANC) contacts are associated with facility-based delivery [5,6,7,8], as are birth planning and complication readiness (BP/CR) interventions [9,10,11]. We implemented group ANC (G-ANC), an alternative service delivery model, in Kenya and Nigeria, to assess its impact on quality and attendance at ANC and uptake of facility-based delivery
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