Child Health In sub-Saharan Africa Research Articles

Protocol of an individual participant data meta-analysis to quantify the impact of high ambient temperatures on maternal and child health in Africa (HE2AT IPD)

IntroductionGlobally, recognition is growing of the harmful impacts of high ambient temperatures (heat) on health in pregnant women and children. There remain, however, major evidence gaps on the extent to...

Developing the BornFyne prenatal management system version 2.0: a mixed method community participatory approach to digital health for reproductive maternal health

ABSTRACT Despite the growing number of global initiatives aimed at reducing adverse maternal health outcomes, there remain critical gaps and disparities in access to maternal health services in Cameroon and across the sub-Saharan Africa. Digital health innovations represent unique opportunities for addressing maternal and newborn child health in sub-Saharan Africa. This article documents the approach to developing the BornFyne-Prenatal Management System (PNMS) as an intervention to support maternal health issues in Cameroon. The mixed-method design employed the three-delays model conducted in four health districts purposefully selected with a mix of urban and rural settings as defined in the context. The study employed focus group discussions and interviews to inform the development features. A total of 25 providers were interviewed, 12 focus group discussions and 4 workshops were held and a total of 3654 households were surveyed. Participants highlighted multifaceted advantages of using digital health platform such as BornFyne-PNMS to enhance communication and care during pregnancy such as remote consultations, emergency response, increased patient engagement and improved continuity of care and convenience. Most respondents believed that the use of a digital platform like BornFyne-PNMS would greatly facilitate access to health facilities, especially during emergencies. The BornFyne-PNMS deployment includes community engagement, training and practical skills building of health workers in the use of digital technologies, the establishment of an emergency transport mechanism for response to emergency cases, assessment and upgrading of the computer hardware of enrolled health facilities and support to health system managers to review and interpret the BornFyne data and interoperability with the national health management information system.

Contextualizing Maternal Education and Child Health in Sub-Saharan Africa: The Role of Intimate Partner Violence

We examined how the relationship between maternal education and child health varies across women’s status and safety using pooled Demographic and Health Survey data from 24 sub-Saharan African countries. While maternal education was associated with less child stunting, wasting, and underweight, the effect of maternal education on stunting and underweight was attenuated among women who experienced high levels of intimate partner violence (IPV). Further, the positive influence of maternal education on stunting and underweight was less pronounced among women who lived in communities with higher levels of IPV, even after controlling for women’s own IPV. This suggests that the returns of maternal education may be dampened in the presence of IPV. The fact that this link operates at both individual and community levels underscores how gender norms, patriarchy, and gender-based violence stifle progress on children’s health. The results also demonstrate how the UN Sustainable Development Goals strengthening maternal education, improving child health, and reducing intimate partner violence must be jointly pursued and the importance of considering how child health outcomes may be tempered by context.

Impact of COVID-19 pandemic on mother and child health in Sub-Saharan Africa - a review.

Prior to the outbreak of the coronavirus disease 2019 (COVID-19) pandemic, there was a decrease in the maternal mortality rate in Sub-Saharan Africa (SSA) by 38%. This corresponds to a decline of 2.9% on average each year. In spite of this reduction, it falls short of the 6.4% annual rate required to reach the global Sustainable Development Goal of 70 maternal deaths per 100,000 live births. This study reviewed the impact of COVID-19 on maternal and child health. Due to the major challenge of the health systems and lack of strategies in preparation for emergencies, several studies have reported significant impacts of COVID-19 on women and children in SSA. Global estimates of the indirect impacts of COVID-19 suggested a 38.6% increase in maternal mortality and a 44.7% increase in child mortality per month across 118 low- and middle-income countries. The COVID-19 pandemic has threatened the continuity of essential mother-to-child healthcare service delivery in SSA. It is important for health systems to address these challenges as lessons learnt for future health crises and to develop adequate response policies and programs for emerging diseases of public health importance. IMPACTS: This literature review will provide in-depth insight into the impact of COVID-19 on maternal and child health, particularly in Sub-Saharan Africa. The findings of this literature review suggest to the concerned health systems the need to prioritize women's antennal care for the safety of the baby. The findings of this literature review will aid the basis for intervention in maternal and child health and reproductive health in general.

Assessment of Interventions in Primary Health Care for Improved Maternal, New-born and Child Health in Sub-Saharan Africa: A Systematic Review

Primary health care (PHC) holds great potentials to improve maternal, newborn, and child health (MNCH) outcomes. However, there has been limited documentation of its effects on increasing universal access to maternal, newborn, and child health services in sub-Saharan Africa. Also, not adequately known are the most effective interventions to improve the delivery of PHC services in the region. The objective of this study was to conduct a systematic review of empirical evidence of interventions that improved access and quality of PHC services for maternal, newborn, and child health in sub-Saharan Africa. The protocol was registered on Prospero (Registration number CRD42019126029). Using terms related to primary health care and MNCH, we searched African Journals Online (AJOL), PubMed/Medline, Popline, ScienceDirect, Google Scholar, WHO Repository (IRIS), Directory of Open Access Journals (DOAJ), Cochrane Library, and reference lists for studies published in English between 2000 and 2019. Studies were included in the search if they reported interventions, and strategies implemented to improve quality and access to primary health care for maternal, newborn, and child health in sub-Saharan Africa. A total of 25 studies were included in the review. Effective interventions included financial incentives, task-shifting, community-directed engagements, training of providers, mobile health, cost-sharing, and supportive supervision among others. The result of this review contributes useful insight to guide the reformation, and development of new policies and programs for improving access and quality of primary health care delivery in sub-Saharan Africa, particularly to improve maternal and child health in the region. However, strategies to scale and sustain the successes need to be in place.

Determinants of community health workers effectiveness for delivery of maternal and child health in Sub Saharan Africa: A Systematic review protocol.

BackgroundCountries in sub-Sahara African continue to have the highest maternal and under- five child death occurrences in the world and this has become a key health challenge in the region and persists as global public health agenda. Although Community Health Workers (CHWs) are increasingly being acknowledged as crucial members of the healthcare workforce in reducing health disparity, evidence is limited on perspective of community health workers. The objective of this protocol is to outline the methodological process of a systematic review that will gather qualitative data to examine determinants of community health workers effectiveness for delivery of maternal and child health in Sub Saharan Africa. Synthesizing the perspectives of community health workers’ perceived experience is crucial to inform decision makers, policy makers, and practitioners to address barriers to and scaleup facilitators of CHWs program to ensure maternal and child health equity and a resilience community health system.MethodsThe protocol has been registered in the PROSPERO (CRD42020206874). We will systematically conduct a literature search from inception in MEDLINE complete, EMBASE, CINAHL complete and Global Health for relevant studies. Eligible studies will be reports of original research, peer reviewed articles having a qualitative component (i.e., qualitative, mixed, or multi-method studies) on empowerment of CHWs associated with maternal and child health in the sub-Saharan Africa. Eligibility will be restricted to studies published in English. Two reviewers will independently screen all included abstracts and full-text articles. The primary outcome will be CHWs’ perceived barriers to and facilitators of effectiveness of community health workers in maternal and child health in sub-Saharan Africa. Study methodological quality (or bias) will be appraised using appropriate tools. Narrative analysis will be conducted, and narrative summary of findings will be presented. We will use the ‘best fit’ framework method as a systematic approach to analyzing the qualitative data.DiscussionThis study will systematically and comprehensively search literature and integrate evidence on perceived barriers to and facilitators of effectiveness of community health workers led maternal and child health program in sub-Saharan Africa. Our findings will inform policy and practice on maternal and child health equity and a resilient communities health system. The resulting manuscript will be disseminated in a peer-reviewed journal and at international and national conferences.

Assessing the effects of mining projects on child health in sub-Saharan Africa: a multi-country analysis

BackgroundThe African continent hosts many industrial mining projects, and many more are planned due to recent prospecting discoveries and increasing demand for various minerals to promote a low-carbon future. The extraction of natural resources in sub-Saharan Africa (SSA) represents an opportunity for economic development but also poses a threat to population health through rapid urbanisation and environmental degradation. Children could benefit from improved economic growth through various channels such as access to high-quality food, better sanitation, and clean water. However, mining can increase food insecurity and trigger local competition over safe drinking water. Child health can be threatened by exposure to mining-related air, noise, and water pollution. To assess the impact of mines on child health, we analyse socio-demographic, health, and mining data before and after several mining projects were commissioned in SSA.ResultsData of 90,951 children living around 81 mining sites in 23 countries in SSA were analysed for child mortality indicators, and 79,962 children from 59 mining areas in 18 SSA countries were analysed for diarrhoea, cough, and anthropometric indicators. No effects of the launch of new mining projects on overall under-five mortality were found (adjusted Odds Ratio (aOR): 0.88; 95% Confidence Interval (CI): 0.68–1.14). However, activation of mining projects reduced the mortality risk among neonates (0–30 days) by 45% (aOR: 0.55; 95% CI: 0.37–0.83) and risk for a child to develop diarrhoeal diseases by 32% (aOR: 0.68; 95% CI: 0,51–0.90). The timing analysis of observed changes showed that there is a significant decline in the risk for childhood diarrhoea (aOR: 0.69; 95% CI: 0.49–0.97), and the mean height-for-age z-scores by 28 percentage points, during the prospection and construction phase; i.e., within four years to the initiation of extraction activity. No effects were found for cough and weight-for-height.ConclusionThe results presented suggest that the impacts of mining on child health vary throughout the mine’s life cycle. Mining development likely contributes positively to the income and livelihoods of the impacted communities in the initial years of mining operations, particularly the prospection and construction phase; these potential benefits are likely to be at least partially offset by food insecurity and environmental pollution during early and later mining stages, respectively. Further research is warranted to better understand these health impacts and to identify policies that can help sustain the positive initial health impacts of mining projects in the long term.

Secondary Education and its Effects on Child Health: Empirical Evidence from Sub-Saharan Africa

Sub-Saharan Africa (SSA) experience higher under-five mortality compared to other regions. This study examines the effect of lagged parent’s secondary education on child health outcome in sub-Saharan Africa countries. It applies the System GMM (Generalized Method of Moments) estimator for 17 years period from 2000 to 2016 using a panel data of 33 selected countries. The findings show strong evidence that lagged parent’s secondary education; income (GDP per capita) and measles immunization have significant effects on improvements of child health in sub-Saharan Africa. Increasing an access to secondary education in the region has achieved better child health status over the period 2000-2016. Lagged parent’s education skills acquired in leaving secondary school are the most important channels that affect child health. The findings suggest expanding and strengthening secondary education in sub-Saharan Africa to meet a Sustainable Development Goal target (SDG) in reducing under-five mortality by the year 2030.

Incomes and Child Health in Sub-Saharan Africa, 1990–2018

Abstract This paper investigates the relationship between real incomes in Sub-Saharan African countries during 1990–2018 and child wellbeing. A new UNICEF-WHO-World Bank database of child growth and malnutrition and annual measures of child mortality from the World Development Indicators are employed. Changes in real incomes are related to changes in these measures. Real incomes are found to be strongly negatively conditionally associated with stunting, underweight and child mortality. The fraction of each country’s export revenue derived from major non-agricultural export commodities in 1990 is then used to construct a counterfactual value of export revenues. This measure is used to predict real incomes in a country in a year. The impact of incomes on child mortality outcomes is then assessed. Instrumental variables results suggest that improved incomes may have causally reduced neonatal and under-five mortality.

Prenatal Exposure to Heat Waves and Child Health in Sub-Saharan Africa

This paper investigates the consequences of prenatal exposure to hot temperatures on child health in Sub-Saharan Africa (SSA) using a novel indicator of heat waves (the Heat Wave Magnitude Index daily). Leveraging several geo-referenced waves of the Demographic and Health Surveys merged with gridded data on the presence of heat waves and their magnitude since the 1980s, we investigate the effects of inutero exposure to heat waves on several birth and early childhood health outcomes (birth weight, low birth weight, weight-for-age and height-for-age z-scores, undernutrition, severe undernutrition, stunting, severe stunting, anemia). Our analysis demonstrates very robust negative effects on long-term child health, namely the probability that the child is severely stunted. Effects are larger for in-utero shocks experienced in the second and third trimesters of pregnancy and for heat waves of higher intensity. We further show that, at least in the SSA context, adaptation mechanisms such as access to improved water and sanitation, electricity, and improved housing do not appear to significantly attenuate the negative effects of heat waves.

Using mobile phones to promote maternal and child health: knowledge and attitudes of primary health care providers in southwest Nigeria

Background The use of mHealth by primary health care providers is a unique opportunity to improve maternal and child health in Sub-Saharan Africa. However, few studies have examined the effects of primary health care providers’ knowledge and attitudes of mHealth for maternal and child health promotion in low-resource settings. Therefore, this study assesses the knowledge and attitudes of primary health care providers on the use of mobile technologies such as internet-enabled smartphones for maternal and child health services. Methods We used data from a cross-sectional study of seven urban local government areas in Lagos, Nigeria. A total of 518 primary health care providers were surveyed for information on the use of mobile technologies, attitudes, and actual use of mobile technologies for maternal and child health services. Data were analyzed using descriptive and multivariable linear and logistic regression models. Results Our study showed that smartphone ownership is not a predictor of high mHealth knowledge; however, having an internet-enabled smart phone was a strong predictor of higher knowledge of mHealth (regression coefficient, ß=1.20, 95% confidence interval, CI=0.61-1.79) among primary health care providers. Owning a smartphone (ß=1.00, 95% CI=0.12-1.89) and having internet-enabled phone (ß=1.14, 95% CI=0.18-2.10) were both predictors of positive mHealth attitude. Primary health care providers with higher scores on mHealth knowledge were 1.32 times more likely to use mHealth for maternal and child health services. Similarly, those with positive attitude towards mHealth were 1.15 times more likely to use mobile technology for maternal and child health services. Conclusion The results suggest the use of mHealth tools by primary health care providers to render maternal and child health services is affected by their knowledge and attitude towards mHealth. Interventions that focus on increasing mobile technologies with internet enabled devices like smartphones are needed to improve knowledge, attitudes, and use of mHealth in maternal and child health services.

Improving Child Survival in Sub-Saharan Africa: Key Environmental and Nutritional Interventions.

Many countries in Sub-Saharan Africa (SSA), did not achieve the Millennium Development Goal 4 target of reducing under-five mortality by two-thirds between 1990 and 2015. A large proportion of under-five deaths in SSA and other developing regions have been attributed to undernutrition and poor household environmental conditions. Failure to address nutritional deficit and household environmental pollution in SSA will therefore likely result in many countries not meeting the Sustainable Development Goal (SDG) 3.2 target which aims to reduce under-five mortality to less than 25 deaths per 1000 livebirths by 2030. This paper pinpoints the nutritional and environmental threats to child health in SSA, and identify interventions that will work best to improve child survival in countries. It is important to broaden the spectrum of interventions for improving child survival beyond health systems strengthening to enable countries meet the SDG 3.2 target. The following interventions are thus proposed: strengthening child welfare clinics through digital technologies; investment in school feeding programmes; addressing household air pollution; and improving water, sanitation and hygiene (WASH) services in basic schools. There are certainly barriers to effective implementation of the proposed interventions in countries but are surmountable with strong political will and involvement of the private sector.

Housing and child health in sub-Saharan Africa: A cross-sectional analysis.

BackgroundHousing is essential to human well-being but neglected in global health. Today, housing in Africa is rapidly improving alongside economic development, creating an urgent need to understand how these changes can benefit health. We hypothesised that improved housing is associated with better health in children living in sub-Saharan Africa (SSA). We conducted a cross-sectional analysis of housing conditions relative to a range of child health outcomes in SSA.Methods and findingsCross-sectional data were analysed for 824,694 children surveyed in 54 Demographic and Health Surveys, 21 Malaria Indicator Surveys, and two AIDS Indicator Surveys conducted in 33 countries between 2001 and 2017 that measured malaria infection by microscopy or rapid diagnostic test (RDT), diarrhoea, acute respiratory infections (ARIs), stunting, wasting, underweight, or anaemia in children aged 0–5 years. The mean age of children was 2.5 years, and 49.7% were female. Housing was categorised into a binary variable based on a United Nations definition comparing improved housing (with improved drinking water, improved sanitation, sufficient living area, and finished building materials) versus unimproved housing (all other houses). Associations between house type and child health outcomes were determined using conditional logistic regression within surveys, adjusting for prespecified covariables including age, sex, household wealth, insecticide-treated bed net use, and vaccination status. Individual survey odds ratios (ORs) were pooled using random-effects meta-analysis. Across surveys, improved housing was associated with 8%–18% lower odds of all outcomes except ARI (malaria infection by microscopy: adjusted OR [aOR] 0.88, 95% confidence intervals [CIs] 0.80–0.97, p = 0.01; malaria infection by RDT: aOR 0.82, 95% CI 0.77–0.88, p < 0.001; diarrhoea: aOR 0.92, 95% CI 0.88–0.97, p = 0.001; ARI: aOR 0.96, 95% CI 0.87–1.07, p = 0.49; stunting: aOR 0.83, 95% CI 0.77–0.88, p < 0.001; wasting: aOR 0.90, 95% CI 0.83–0.99, p = 0.03; underweight: aOR 0.85, 95% CI 0.80–0.90, p < 0.001; any anaemia: aOR 0.87, 95% CI 0.82–0.92, p < 0.001; severe anaemia: aOR 0.89, 95% CI 0.84–0.95, p < 0.001). In comparison, insecticide-treated net use was associated with 16%–17% lower odds of malaria infection (microscopy: aOR 0.83, 95% CI 0.78–0.88, p < 0.001; RDT: aOR 0.84, 95% CI 0.79–0.88, p < 0.001). Drinking water source and sanitation facility alone were not associated with diarrhoea. The main study limitations are the use of self-reported diarrhoea and ARI, as well as potential residual confounding by socioeconomic position, despite adjustments for household wealth and education.ConclusionsIn this study, we observed that poor housing, which includes inadequate drinking water and sanitation facility, is associated with health outcomes known to increase child mortality in SSA. Improvements to housing may be protective against a number of important childhood infectious diseases as well as poor growth outcomes, with major potential to improve children’s health and survival across SSA.

Dimensions of Governance and Child Health in Sub-Saharan Africa: A Subnational Analysis

There is broad consensus in the literature on development that effective governance is one of the keys to development. It is against this background of the relationship between good governance and socioeconomic development that the African Union (AU), following its establishment in 2000, indicated good governance in its constitutive act as part of its policy framework for member states in line with the tenets of the New Partnership for Africa’s Development (NEPAD) and the African Peer Review Mechanism (APRM). The present study examined the relationship between good governance and less child deprivation using pooled data from Afrobarometer surveys and Demographic and Health Surveys conducted in sub-Saharan countries since 2000. The study examined the relationship between such dimensions of governance as democracy, voting, effectiveness and transparency as measured by trust and corruption as well as measures of child outcomes such as availability of toilet facilities, vaccinations, nutrition and mortality. The study found that the relationship between regional governance and children’s well-being was weak and inconsistent. It indicated that although a deepening of democracy might lead to improvements in the long-term outcomes of nutrition and child survival, these improvements would be relatively small. Further, results suggested that, in terms of good governance, trust was not particularly helpful and that corruption was not as harmful as many would suggest.

An Assessment of Domestic Financing for Reproductive, Maternal, Neonatal and Child Health in Sub-Saharan Africa: Potential Gains and Fiscal Space.

BackgroundReproductive, maternal, neonatal and child health (RMNCH) remains an important public health objective. In sub-Saharan Africa (SSA), inadequate financial commitment continues to pose a major challenge to improving RMNCH outcomes. Understanding financing gains and potential fiscal space for RMNCH can therefore not be overemphasized.ObjectiveThis study sought to analyse the potential gains from increased domestic financing as a source for improving RMNCH outcomes in SSA. We also assessed, in addition to the potential gains, the potential fiscal space available for financing RMNCH in SSA.MethodsOur study used panel econometric techniques to estimate gains from increased health financing in terms of RMNCH. We also reviewed tax system performance as well as debt sustainability to identify fiscal space potentials across countries.ResultsWe found significant gains from both domestic and external financing. The estimated elasticities suggest that the gains from domestic public financing were much stronger. The fiscal space options identified include tax revenue performance improvements, improved public financial management, and borrowing, at least in the short to medium term. The results show that fiscal space from improved tax systems ranged from US$34.6 per capita in Uganda to US$310.6 per capita in Nigeria.ConclusionThis result reinforces calls for increased domestic financing for health through innovations in domestic resource mobilization. Improving the performance of tax systems will be a step in the right direction, with possible long-term gains to the health sector.

Armed conflicts and national trends in reproductive, maternal, newborn and child health in sub-Saharan Africa: what can national health surveys tell us?

Armed conflicts are widespread in sub-Saharan Africa and considered to be an important factor in slowing down national progress in reproductive, maternal, newborn and child health (RMNCH). The measurement of the impact of conflicts on national levels and trends in RMNCH is difficult. National surveys conducted before and sometimes during and after conflicts are a major source of information on the national and local effects of conflicts on RMNCH. We examined data from national surveys in 13 countries in sub-Saharan Africa with major conflicts during 1990–2016 to assess the levels and trends in RMNCH intervention coverage, nutritional status and mortality in children under 5 years in comparison with subregional trends. The surveys provide substantive evidence of a negative association between levels and trends in national indicators of RMNCH service coverage, child growth and under-5 mortality with armed conflict, with some notable exceptions. National surveys are an important source of data to assess the longer term national consequences of conflicts for RMNCH in most countries, despite limitations due to sampling and timing of the surveys.

Temporal trends in the nutritional status of women and children under five years of age in sub-Saharan African countries: ecological study.

While the global prevalence of obesity is rapidly increasing, this pandemic has received less attention in sub-Saharan Africa, particularly in the light of the persistent undernutrition that exists in the context of maternal and child health. We aimed to describe obesity trends among women of childbearing age over recent decades, along with trends in over and undernutrition among children under five years of age, in sub-Saharan African countries. Ecological study with temporal trend analysis in 13 sub-Saharan African countries. This was a description of temporal trends in nutritional status: adult obesity, childhood overweight, low height-for-age (stunting), low weight-for-height (wasting), low weight-for-age (underweight) and low birth weight. Publicly available data from repeated cross-sectional national surveys (demographic and health surveys and multiple-indicator cluster surveys) were used. We chose 13 sub-Saharan African countries from which at least four surveys conducted since 1993 were available. We investigated women aged 15-49 years and children under five years of age. In multilevel linear models, the prevalence of obesity increased by an estimated 6 percentage points over 20 years among women of childbearing age, while the prevalence of overweight among children under 5 years old was stable. A major decrease in stunting and, to a lesser extent, wasting accompanied these findings. The upward trend in obesity among women of childbearing age in the context of highly prevalent childhood undernutrition suggests that the focus of maternal and child health in sub-Saharan Africa needs to be expanded to consider not only nutritional deficiencies but also nutritional excess.

A scoping review on community mobilisation for maternal and child health in sub-Saharan Africa: Impact on empowerment

ABSTRACTThis review integrates evidence on community mobilisation (CM) for maternal and child health in sub-Saharan Africa (SSA) to identify the impact on empowerment. For the purposes of this review we use the following definition of CM: ‘a capacity-building process through which community members, groups or organizations plan, carry out and evaluate activities on a participatory and sustained basis to improve their health and other conditions, either on their own initiative or stimulated by others’, [Howard-Grabman, L., Storti, C., Hummer, P., Pooler, B., & Geneva: USAID (2007). Demystifying community mobilization: An effective strategy to improve maternal and newborn health. Retrieved from http://pdf.usaid.gov/pdf_docs/pnadi338.pdf, p. 5]. A scoping review was chosen to conduct a search and analysis of the literature due to the broad, complex nature of the topic. The search yielded 136 articles, and 19 met the inclusion criteria. This review illustrates CM as an important research process for engaging the community, ensuring that interventions are meeting the needs of the community, take context into account and are sustainable. Community mobilisation was associated with positive behaviour change and/or health outcomes. However, community mobilisation was not defined or operationalised consistently among the identified studies. Empowerment was also not defined, measured, or reported on in the articles. This review provides recommendations for the reporting of CM and its influence on empowerment in communities in sub-Saharan Africa.

Polygynous marriage and child health in sub-Saharan Africa: What is the evidence for harm?

Researchers from a variety of disciplines have presented data indicating that polygynous marriage is damaging to child health. This work has been used to support the classification of polygyny as a ‘harmful cultural practice’ and to advocate for marital re

Quality of care in six sub-Saharan Africa countries: a provider-based study on adherence to WHO's antenatal care guideline.

Quality of care may help explain the high burden of disease in maternal, newborn and child health in low- and middle-income countries even as access to care is improved. We explored the determinants of quality of antenatal care (ANC) in sub-Saharan Africa (SSA). Cross-sectional study. Multilevel Generalized Linear Latent Mixed-Effect models with logit link function were employed to obtain the adjusted odds ratios (AORs) and 95% confidence interval (CI). We used Service Provision Assessment data from six countries in SSA, including Kenya, Malawi, Namibia, Rwanda, Tanzania and Uganda. Seven thousand, five hundred and seventy seven observed antenatal clients across the six countries. Quality of ANC services, measured using indexes of quality of clinical care and quality of information provided. Providers in facilities that had ANC guideline (AOR = 1.26; 95% CI, 1.08-1.48), were well-equipped (AOR = 1.65; 95% CI, 1.41-1.92), were classified as upper level facility (AOR = 1.32; 95% CI, 1.05-1.66), had central electricity supply (AOR = 2.19; 95% CI, 1.81-2.65), and piped water (AOR = 1.30; 95% CI, 1.09-1.55) were more likely to provide optimal quality of clinical care. Moreover, those having ANC guideline (AOR = 1.81; 95% CI, 1.43-2.28) and central electricity supply (AOR = 2.67; 95% CI, 2.01-3.44) were more likely to provide optimal information as well. Provider's qualification and experience were also important in information provision and clinical care independently. The lack of some very basic facility equipment and amenities compromised quality of care in sub-Saharan countries. Policy actions and investment on facility and providers will enable provision of quality services necessary to improve maternal, newborn and child health in SSA.