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Association between early antenatal care and antenatal care contacts across low-and middle-income countries: effect modification by place of residence
Paschal Awingura Apanga, Maxwell Tii Kumbeni
Epidemiol Health. 2021;43:e2021092.   Published online November 2, 2021
DOI: https://doi.org/10.4178/epih.e2021092
  • 8,741 View
  • 156 Download
  • 6 Web of Science
  • 5 Crossref
AbstractAbstract AbstractSummary PDFSupplementary Material
Abstract
OBJECTIVES
The relationship between receiving early antenatal care (ANC) and 8 or more antenatal contacts (ANC8+) has not been well characterised across low-and middle-income countries (LMICs). It is also unclear whether the association between early ANC and ANC8+ is modified by a woman’s place of residence. Our primary aim was to assess the relationship between early ANC and ANC8+ and to investigate whether this relationship was modified by place of residence. We also estimated the coverage of ANC8+ across LMICs.
METHODS
We analysed data on 207,388 mothers with a recent live birth using multiple indicator cluster surveys conducted between 2017 and 2020 in 30 LMICS. Modified Poisson regression with robust variance was used to evaluate the relationship between early ANC and ANC8+, whilst adjusting for country, clustering, stratification, and sampling weights. Effect modification by place of residence was assessed on additive and multiplicative scales. A meta-analysis was conducted to pool prevalence estimates of ANC8+ across all countries.
RESULTS
The overall prevalence of ANC8+ was 35.6%, ranging from 1.7% in Madagascar to 99.4% in Belarus. Early ANC was positively associated with ANC8+ (adjusted prevalence ratio [aPR], 2.61; 95% confidence interval [CI], 1.82 to 3.74). There was evidence of positive effect modification on additive (relative excess risk due to interaction, 0.39; 95% CI, 0.35 to 0.44) and multiplicative (aPR, 1.78; 95% CI, 1.08 to 2.95) scales.
CONCLUSIONS
Many LMICs may not have adopted the 2016 World Health Organization guidelines on ANC8+. Receiving early ANC was associated with a higher likelihood of ANC8+, particularly for women in rural areas.
Summary
Key Message
Our findings suggest that early antenatal care (ANC) was associated with the likelihood of receiving eight or more ANC contacts (ANC8+) among all mothers across low-and middle-income countries. This association was modified by a woman’s place of residence such that mothers living in rural areas who received early ANC had a higher prevalence of ANC8+. Public health programs, which focus on increasing the coverage of ANC8+ should encourage all pregnant women to receive early ANC, particularly those living rural areas.

Citations

Citations to this article as recorded by  
  • The practice of polygyny on the utilisation of reproductive health services among married women in Ghana
    Maxwell Tii Kumbeni, John Ndebugri Alem, Florence Assibi Ziba, Agani Afaya, Paschal Awingura Apanga
    Journal of Biosocial Science.2024; : 1.     CrossRef
  • Time to initiation of antenatal care and its predictors among pregnant women in Ethiopia: a multilevel mixed-effects acceleration failure time model
    Befekadu Tesfaye Oyato, Husen Zakir Abasimel, Derara Girma Tufa, Hana Israel Gesisa, Tewodros Getachew Tsegaye, Mukemil Awol
    BMJ Open.2024; 14(4): e075965.     CrossRef
  • Determinants of Focused Antenatal Care Utilization Among Women in Simiyu Region Tanzania
    Agatha F. Ngowi, Serafina Mkuwa, Laura Shirima, Frida Ngalesoni, Gasto Frumence
    SAGE Open Nursing.2023; 9: 237796082311707.     CrossRef
  • Contents of antenatal care services in Afghanistan: findings from the national health survey 2018
    Muhammad Haroon Stanikzai, Essa Tawfiq, Massoma Jafari, Abdul Wahed Wasiq, Mohammad Khaled Seddiq, Sheena Currie, Hadia Sayam, Ahmad Haroon Baray, Sayed Ataullah Saeedzai
    BMC Public Health.2023;[Epub]     CrossRef
  • The moderating role of partners’ education on early antenatal care in northern Ghana
    Paschal Awingura Apanga, Maxwell Tii Kumbeni, James Kotuah Sakeah, Ayokunle A. Olagoke, Olufemi Ajumobi
    BMC Pregnancy and Childbirth.2022;[Epub]     CrossRef
Modification of the effect of ambient air temperature on cardiovascular and respiratory mortality by air pollution in Ahvaz, Iran
Sohrab Iranpour, Soheila Khodakarim, Abbas Shahsavani, Ardeshir Khosravi, Koorosh Etemad
Epidemiol Health. 2020;42:e2020053.   Published online July 18, 2020
DOI: https://doi.org/10.4178/epih.e2020053
  • 11,078 View
  • 224 Download
  • 6 Web of Science
  • 2 Crossref
AbstractAbstract PDFSupplementary Material
Abstract
OBJECTIVES
This study investigated the modification of temperature effects on cardiovascular and respiratory mortality by air pollutants (particulate matter less than 2.5 and 10 µm in diameter [respectively], ozone, nitrogen dioxide, carbon monoxide, and sulfur dioxide).
METHODS
Poisson additive models with a penalized distributed lag non-linear model were used to assess the association of air temperature with the daily number of deaths from cardiovascular and respiratory diseases in Ahvaz, Iran from March 21, 2014 to March 20, 2018, controlling for day of the week, holidays, relative humidity, wind speed, air pollutants, and seasonal and long-term trends. Subgroup analyses were conducted to evaluate the effect modification for sex and age group. To assess the modification of air pollutants on temperature effects, the level of each pollutant was categorized as either greater than the median value or less than/equal to the median value.
RESULTS
We found no significant associations between temperature and cardiovascular and respiratory mortality. In the subgroup analyses, however, high temperatures were significantly associated with an increased risk of cardiovascular mortality among those 75 years old and older, with the strongest effect observed on day 0 relative to exposure. The results revealed a lack of interactive effects between temperature and air pollutants on cardiovascular and respiratory mortality.
CONCLUSIONS
A weak but significant association was found between high temperature and cardiovascular mortality, but only in elderly people. Air pollution did not significantly modify the effect of ambient temperature on cardiovascular and respiratory mortality.
Summary

Citations

Citations to this article as recorded by  
  • Associations between ambient temperature and suicide: а systematic review
    Andrej М. Grjibovski, Ivan М. Kobelev, Natalia N. Kukalevskaya, Yulia A. Popova, Alexander V. Baranov
    Ekologiya cheloveka (Human Ecology).2023; 30(6): 399.     CrossRef
  • Combined effects of air pollution and extreme heat events among ESKD patients within the Northeastern United States
    Richard V. Remigio, Hao He, Jochen G. Raimann, Peter Kotanko, Frank W. Maddux, Amy Rebecca Sapkota, Xin-Zhong Liang, Robin Puett, Xin He, Amir Sapkota
    Science of The Total Environment.2022; 812: 152481.     CrossRef

Epidemiol Health : Epidemiology and Health