scholarly journals The impact of antenatal care on under‐five mortality in Ethiopia: a difference‐in‐differences analysis

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Samuel Oduse ◽  
Temesgen Zewotir ◽  
Delia North
Keyword(s):  
Antenatal Care ◽  
Child Survival ◽  
First Trimester ◽  
Sub Saharan Africa ◽  
P Value ◽  
Difference In Differences ◽  
Under Five ◽  
Care Services ◽  
Sub Saharan ◽  
The Impact

Abstract Background Sub-Saharan Africa, as opposed to other regions, has the highest under-five mortality rates yet makes the least improvement in reducing under-five mortality. Despite the decline, Ethiopia is among the top ten countries contributing the most to global under-five mortalities. This article examines the impact of the number of antenatal care and the timing of first antenatal care on child health outcomes. We specifically investigated if the utilization of antenatal care services positively affects the reduction of under-five mortality. Methods We employ a difference-in-differences design with propensity score matching to identify direct causal effects of antenatal care on under-five mortality based on the Ethiopian Demographic Health Survey data of 2011 and 2016. Our sample includes 22 295 women between the ages of 14–49 who had antenatal care visits at different times before delivery. Results The study revealed 1 481 cases of reported under-five mortality. 99.0% of that under-five mortality cases are women who had less than eight antenatal care visits, while only 1% of that is by women who had eight or more antenatal care visits. Antenatal care visit decreases the likelihood of under-five mortality in Ethiopia by 45.2% (CI = 19.2–71.3%, P-value < 0.001) while the timing of first antenatal care within the first trimester decreases the likelihood of under-five mortality by 10% (CI = 5.7–15.6%, P-value < 0.001). Conclusions To achieve a significant reduction in the under-five mortality rate, Intervention programs that encourages more antenatal care visits should be considered. This will improve child survival and help in attaining Sustainable Development Goal targets.

scholarly journals The impact of antenatal care on child mortality in Ethiopia: a difference-in-differences analysis

2020 ◽  
Author(s):  
Samuel Oduse ◽  
Temesgen Zewotir ◽  
Delia North
Keyword(s):  
Antenatal Care ◽  
Child Survival ◽  
Control Group ◽  
Antenatal Visit ◽  
Difference In Differences ◽  
Under Five ◽  
Antenatal Care Visit ◽  
Care Services ◽  
Care Visit ◽  
The Impact

Abstract Background This article examines the impact of antenatal care on child health outcome. We specifically investigated if women visits to antenatal care services has a positive effect in the reduction of under-five mortality. Methods We employ a difference-in-differences design with propensity score matching to identify direct causal effects of antenatal care on under-five mortality based on the Ethiopian Demographic Health Survey data of 2011 and 2016. Our sample includes 22 295 women between the ages of 14-49 years who have at least one antenatal care visit before delivery (treatment group) or had no antenatal care visit before delivery (control group). Results The study revealed 1 481 cases of reported under-five mortality. 83.7% of that is by women who never had any antenatal care visit while the remaining 16.3% are by women who had at least one antenatal visit during their pregnancy. Antenatal care visit decreases the likelihood of under-five mortality in Ethiopia by 29% (CI = 1.3-56%, P= 0.04). Conclusions To achieve significant reduction in under-five mortality rate, Intervention programs that encourages antenatal care visits should be considered. This will improve child survival and help in attaining sustainable Development Goal target.

scholarly journals The impact of antenatal care on neonatal mortality in sub-Saharan Africa: A systematic review and meta-analysis

PLoS ONE ◽  
2019 ◽  
Vol 14 (9) ◽  
pp. e0222566 ◽  
Author(s):  
Tesfalidet Tekelab ◽  
Catherine Chojenta ◽  
Roger Smith ◽  
Deborah Loxton
Keyword(s):  
Systematic Review ◽  
Antenatal Care ◽  
Neonatal Mortality ◽  
Meta Analysis ◽  
Sub Saharan Africa ◽  
Sub Saharan ◽  
The Impact

scholarly journals Impact of Feed the Future initiative on nutrition in children aged less than 5 years in sub-Saharan Africa: difference-in-differences analysis

BMJ ◽  
2019 ◽  
pp. l6540 ◽  
Author(s):  
Theresa Ryckman ◽  
Margaret Robinson ◽  
Courtney Pedersen ◽  
Jay Bhattacharya ◽  
Eran Bendavid
Keyword(s):  
Sub Saharan Africa ◽  
Difference In Differences ◽  
Large Country ◽  
Middle Income ◽  
National Differences ◽  
Low Weight ◽  
The Future ◽  
Sub Saharan ◽  
Feed The Future ◽  
The Impact

AbstractObjectiveTo evaluate the impact of the US government’s Feed the Future initiative on nutrition outcomes in children younger than 5 years in sub-Saharan Africa.DesignDifference-in-differences quasi-experimental approach.SettingHouseholds in 33 low and lower middle income countries in sub-Saharan Africa.Population883 309 children aged less than 5 years with weight, height, and age recorded in 118 surveys conducted in 33 countries between 2000 and 2017: 388 052 children were from Feed the Future countries and 495 257 were from non-Feed the Future countries.Main outcome measuresA difference-in-differences approach was used to compare outcomes among children in intervention countries after implementation of the initiative with children before its introduction and children in non-intervention countries, controlling for relevant covariates, time invariant national differences, and time trends. The primary outcome was stunting (height for age >2 standard deviations below a reference median), a key indicator of undernutrition in children. Secondary outcomes were wasting (low weight for height) and underweight (low weight for age).ResultsAcross all years and countries, 38.3% of children in the study sample were stunted, 8.9% showed wasting, and 21.3% were underweight. In the first six years of Feed the Future’s implementation, children in 12 countries with the initiative exhibited a 3.9 percentage point (95% confidence interval 2.4 to 5.5) greater decline in stunting, a 1.1 percentage point (0.1 to 2.1) greater decline in wasting, and a 2.8 percentage point (1.6 to 4.0) greater decline in underweight levels compared with children in 21 countries without the initiative and compared with trends in undernutrition before Feed the Future was launched. These decreases translate to around two million fewer stunted and underweight children aged less than 5 years and around a half million fewer children with wasting. For context, about 22 million children were stunted, 11 million children were underweight, and four million children were wasted in the Feed the Future countries at baseline.ConclusionsFeed the Future’s activities were closely linked to notable improvements in stunting and underweight levels and moderate improvements in wasting in children younger than 5 years. These findings highlight the effectiveness of this large, country tailored initiative focused on agriculture and food security and have important implications for the future of this and other nutrition interventions worldwide.

scholarly journals Prevalence and factors associated with late antenatal care visit among pregnant women in Lushoto, Tanzania

2017 ◽  
Vol 19 (3) ◽  
Author(s):  
Flora Njiku ◽  
Herman Wella ◽  
Adellah Sariah ◽  
Joyce Protas
Keyword(s):  
Antenatal Care ◽  
Pregnant Women ◽  
Health Care Services ◽  
First Trimester ◽  
Antenatal Clinic ◽  
World Health ◽  
P Value ◽  
Cross Sectional ◽  
Factors Associated ◽  
Care Services

Background: Adequate utilization of antenatal health care services is associated with improved maternal and neonatal health outcomes. The World Health Organization recommends pregnant women to attend antenatal care services as early as in the first trimester. However, many women due to various reasons fail to meet the recommendations. The objective of this study was to determine the prevalence and factors associated with late antenatal booking among pregnant women in Lushoto district of north-eastern Tanzania.Methods: This hospital based cross sectional study involved pregnant women and was conducted in August-September 2015. A standardized questionnaire was used to obtain participants demographic characteristics and obstetrics history. Data analysis was done using (SPSS) and relationship between outcome variables and exposure variable was done using Chi-square test. Multivariate logistic regression was used to measure the association.Results: A total of 240 participants were involved in the study.  Out of these, 169 (70.4%) participants booked late for antenatal care (ANC) services. Delayed booking was mainly associated with not being married (AOR=3.08; 95%CI 1.149-8.275; P value=0.025) and unemployment (AOR=4.28; 95% CI 2.11-8.679; p-value=0.000)Conclusion:  Late first antenatal clinic visit was high in Lushoto, and was highly associated with unmarried and unemployment status. Therefore, provision of continuous health education and community sensitization on the importance of timely seeking ANC services should be strengthened.

scholarly journals Effect of health systems context on infant and child mortality in sub-Saharan Africa from 1995 to 2015, a longitudinal cohort analysis

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Ryan A. Simmons ◽  
Rebecca Anthopolos ◽  
Wendy Prudhomme O’Meara
Keyword(s):  
Health Service ◽  
Cohort Analysis ◽  
Child Survival ◽  
Sub Saharan Africa ◽  
Survival Models ◽  
Poor Child ◽  
Risk Of Death ◽  
Increased Risk ◽  
Sub Saharan ◽  
The Impact

AbstractEach year, > 3 million children die in sub-Saharan Africa before their fifth birthday. Most deaths are preventable or avoidable through interventions delivered in the primary healthcare system. However, evidence regarding the impact of health system characteristics on child survival is sparse. We assembled a retrospective cohort of > 250,000 children in seven countries in sub-Saharan Africa. We described their health service context at the subnational level using standardized surveys and employed parametric survival models to estimate the effect of three major domains of health services—quality, access, and cost—on infant and child survival, after adjusting for child, maternal, and household characteristics. Between 1995 and 2015 we observed 13,629 deaths in infants and 5149 in children. In fully-adjusted models, the largest effect sizes were related to fees for services. Immunization fees were correlated with poor child survival (HR = 1.20, 95% CI 1.12–1.28) while delivery fees were correlated with poor infant survival (HR = 1.11, 95% CI 1.01–1.21). Accessibility of facilities and greater concentrations of private facilities were associated with improved infant and child survival. The proportion of facilities with a doctor was correlated with increased risk of death in children and infants. We quantify the impact of health service environment on survival up to five years of age. Reducing health care costs and improving the accessibility of health facilities should remain a priority for improving infant and child survival. In the absence of these fundamental investments, more specialized interventions may not achieve their desired impact.

scholarly journals Explaining socioeconomic disparities and gaps in the use of antenatal care services in 36 countries in sub-Saharan Africa

2021 ◽  
Author(s):  
Amarech G Obse ◽  
John E Ataguba
Keyword(s):  
Antenatal Care ◽  
Pregnant Women ◽  
Social Determinants ◽  
Socioeconomic Inequalities ◽  
Sub Saharan Africa ◽  
Health Coverage ◽  
Care Services ◽  
Effective Interventions ◽  
The Rich ◽  
Sub Saharan

Abstract Significant maternal and child deaths occur in sub-Saharan Africa (SSA) even with existing effective interventions. Antenatal care (ANC), for example, is an intervention that improves the health of pregnant women and their babies, but only 52% of pregnant women in SSA had the recommended minimum of four ANC visits between 2011 and 2016. While significant socioeconomic inequalities in ANC visits have been reported to the disadvantage of the poor, little is known about the depth of ANC coverage and associated inequalities. This paper introduces ‘deficits’ (i.e. the number of ANC visits that are needed to reach the recommended minimum of four ANC visits) and ‘surpluses’ (i.e. the number of ANC visits over and above the recommended minimum of four ANC visits) to assess socioeconomic inequalities in the indicator and depth of the ‘deficits’ and ‘surpluses’ in ANC visits. Using the latest available Demographic and Health Survey data for 36 SSA countries and concentration indices, the paper found that ‘deficits’ in ANC visits are more prevalent among poorer women compared to ‘surpluses’ that are concentrated among the rich. On average, women with ‘deficits’ in ANC visits require about two more ANC visits to reach the recommended four ANC visits, and women with ‘surpluses’ exceeded the recommended minimum by about two ANC visits. The factors that explain a substantial share of the socioeconomic inequalities in ANC ‘deficits’ and ‘surpluses’ in SSA include wealth, education and area of residency, which are essentially the social determinants of health inequalities. For policy response, it is suggested that education is a significant channel to affect the other social determinants of inequalities in ANC coverage reported in the paper. Thus, countries must prioritize quality education as addressing education, especially among women in SSA, will significantly reduce disparities in ANC service utilization and accelerate progress towards universal health coverage.

scholarly journals Water and sanitation influence on child health in Namibia: using demographic and health surveys

2021 ◽  
Author(s):  
Mona Abdelhady ◽  
Anna Alfeus ◽  
Ndinomholo Hamatui
Keyword(s):  
Child Health ◽  
Health Surveys ◽  
Child Death ◽  
Healthcare Services ◽  
Sub Saharan Africa ◽  
Demographic And Health Surveys ◽  
Under Five ◽  
Sub Saharan ◽  
Child's Death ◽  
The Impact

Abstract Important milestones in reducing child mortality rates have been achieved internationally and in Africa. With 76 deaths per 1,000 live births, sub-Saharan Africa (SSA) continues to have the world's highest under-five mortality (U5M) rate. In SSA, one child in every 13 dies from preventable causes before reaching their fifth birthday. This study sought to determine the impact of demographic, socio-economic, and environmental determinants on child health in Namibia, using the Namibian demographic and health surveys (NDHS) from 2006 and 2013. A logistic regression model was used to determine the association between improved sanitary facilities and water sources and U5M in Namibia. Improved access to sanitation facilities in Namibia is associated with less U5M rate, according to the 2013 survey. No significant association was observed between improved access to safe water and child's death. In 2013, the greater the mother's level of education, the lower the chance of child death. Finally, the findings demonstrate that mothers with HIV-positive are more likely to experience under-five death. Hence, the Namibian government should increase sanitation facilities and promote maternal healthcare services for less fortunate households to lower the U5M rate.

scholarly journals Impact of Intimate Partner violence on ever married women and utilization of antenatal care services in Tanzania

2018 ◽  
Vol 14 (1) ◽  
Author(s):  
S M Yasir Arafat
Keyword(s):  
Intimate Partner Violence ◽  
Antenatal Care ◽  
Partner Violence ◽  
Odds Ratio ◽  
Intimate Partner ◽  
Married Women ◽  
Sub Saharan Africa ◽  
Age Group ◽  
Care Services ◽  
The Impact

<p><strong>Background and Objectives:</strong> Sub Saharan Africa region is considered as one of the deprived regions of this world and women from this part of the world are suffering from intimate partner violence. This study was undertaken to assess the impact of intimate partner violence on utilization of antenatal care services among the ever married women.</p><p><strong>Materials and Methods:</strong> This is a descriptive cross-sectional study design. The data used in this research was extracted from the Tanzania Demographic Health Survey 2015-16. A total of 13, 266 women were interviewed.</p><p><strong>Results:</strong> The mean age of the respondents is 28.69 years. About 74% women visited antenatal care services more than 4 times. Logistic regression results indicate that the middle-aged adult women (35-49 years age group) were identified having lower odds (Odds ratio: 0.807, 95% CI: 0.693-0.940, P&lt;0.001) than women in younger age group. Women who did not complete their secondary education were less likelihood to experience IPV (Odds ratio: 0.705, 95% CI: 0.540-0.922, P&lt;0.010).</p><p><strong>Conclusion:</strong> IPV is one main challenge to women’s health and wellbeing during pregnancy period. Proper implementation and community based interventions to support pregnant women to seek antenatal care services and to raise awareness regarding intimate partner violence are advocated.</p>

scholarly journals Examining barriers to healthcare access and utilization of antenatal care services: evidence from demographic health surveys in sub-Saharan Africa

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Bright Opoku Ahinkorah ◽  
Edward Kwabena Ameyaw ◽  
Abdul-Aziz Seidu ◽  
Emmanuel Kolawole Odusina ◽  
Mpho Keetile ◽  
...  
Keyword(s):  
Antenatal Care ◽  
Healthcare Access ◽  
Sub Saharan Africa ◽  
Care Utilization ◽  
Care Services ◽  
Antenatal Care Utilization ◽  
Health Survey Data ◽  
Barriers To Healthcare ◽  
Sub Saharan ◽  
Barriers To Healthcare Access

Abstract Background Antenatal care utilization is one of the means for reducing the high maternal mortality rates in sub-Saharan Africa. This study examined the association between barriers to healthcare access and implementation of the 2016 WHO antenatal care services model among pregnant women seeking antenatal care in selected countries in sub-Saharan Africa. Methods This study considered only Demographic and Health Survey data collected in 2018 in sub-Saharan Africa. Hence, the Demographic and Health Survey data of four countries in sub-Saharan Africa (Nigeria, Mali, Guinea and Zambia) were used. A sample of 6761 from Nigeria, 1973 from Mali, 1690 from Guinea and 1570 from Zambia was considered. Antenatal care visits, categorized as < 8 visits or ≥8 visits, and time of the first antenatal care visit, categorized as ≤3 months or > 3 months (as per the WHO recommendations) were the outcome variables for this study. Both descriptive statistics and ordinal logistic regression were used to analyze the data. Crude odds ratios (cOR) and adjusted odds ratios (aOR) and p-values < 0.05 were used for the interpretation of results. Results With timing of antenatal care visits, getting money needed for treatment (aOR = 1.38, 95% CI = 1.03–1.92) influenced early timing of antenatal care visits in Mali whereas getting permission to visit the health facility (aOR = 1.62, 95% CI = 1.15–2.33) motivated women to have early timing of antenatal care visits in Guinea. We found that women who considered getting money needed for treatment as not a big problem in Nigeria were more likely to have the recommended number of antenatal care visits (aOR = 1.38, 95% CI= 1.11–1.73). On the contrary, in Guinea, Zambia and Mali, getting permission to visit health facilities, getting money for treatment, distance to the health facility and not wanting to go alone were not barriers to having ≥ 8 antenatal care visits. Conclusion Our study has emphasized the role played by barriers to healthcare access in antenatal care utilization across sub-Saharan African countries. There is the need for governmental and non-governmental organizations to ensure that policies geared towards improving the quality of antenatal care and promoting good interaction between health care seekers and health care providers are integrated within the health system.

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