Abstract
BackgroundThe timing of antenatal care (ANC) visits directly affect health intervention coverage and impact, especially for those interventions requiring strict gestational age windows for administration, such as maternal respiratory syncytial virus (RSV) vaccine. Existing nationally representative population-based surveys do not record the timing of ANC visits beyond the first, limiting the availability of reliable data around timing of subsequent ANC visits in most low- and middle-income countries (LMICs). Here, we describe a model that estimates the timing of ANC visits by gestational age using publicly available multi-country survey data.Methods and findingsWe used the Demographic and Health Surveys (DHS) data from 69 LMICs. We used several factors to estimate the timing of subsequent ANC visits by gestation age: the timing of the first ANC visit (ANC1) in a given pregnancy, derived from the DHS; the country’s reported average ANC coverage at each ANC visit (ANC1 through the fourth ANC visit [ANC4]); and the World Health Organization’s guidance on recommended ANC visit. We then used the timing of ANC visit by gestation age to predict the coverage of a potential maternal RSV vaccine administered at 24–36 weeks of gestation. We calculated the maternal immunization coverage by summing the number of eligible women vaccinated at any ANC visit divided by the total number of pregnant women. We find, in general, countries with higher ANC1 coverage were predicted to have higher vaccination coverage. In 82% of countries, the modeled vaccine coverage is less than ANC4 coverage.ConclusionsThe methods illustrated in this paper have implications on the precision of estimating impact and programmatic feasibility of time-critical interventions, especially for pregnant women. The methods can be easily adapted to vaccine demand forecasts models, vaccine impact assessments, and cost-effectiveness analyses and can be adapted to other maternal interventions that have administration timing restrictions.
Highlights
Improvements in health services and preventive health interventions such as immunization have been critical in reducing neonatal and infant mortality and providing broader health improvement over the past several decades [1]
We used several factors to estimate the timing of subsequent antenatal care (ANC) visits by gestation age: the timing of the first ANC visit (ANC1) in a given pregnancy, derived from the Demographic and Health Surveys (DHS); the country’s reported average ANC coverage at each ANC visit (ANC1 through the fourth ANC visit [ANC4]); and the World Health Organization’s guidance on recommended ANC visit
We used the timing of ANC visit by gestation age to predict the coverage of a potential maternal respiratory syncytial virus (RSV) vaccine administered at 24–36 weeks of gestation
Summary
Improvements in health services and preventive health interventions such as immunization have been critical in reducing neonatal and infant mortality and providing broader health improvement over the past several decades [1]. Given the centrality of ANC as an access point for pregnant women, ANC visits are a potentially promising context in which to deliver maternal vaccines and other services for pregnant women. Additional maternal vaccines are in development, including for respiratory syncytial virus (RSV) and group B streptococcus. While some maternal vaccines, like TTCV, have no restrictions on when they are given, others need to be administered during specific gestational age windows to be most effective. The timing of antenatal care (ANC) visits directly affect health intervention coverage and impact, especially for those interventions requiring strict gestational age windows for administration, such as maternal respiratory syncytial virus (RSV) vaccine. We describe a model that estimates the timing of ANC visits by gestational age using publicly available multi-country survey data
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