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Epidemiol Health > Volume 43; 2021 > Article
Epidemiology and Health 2021;43: e2021092-0.
DOI: https://doi.org/10.4178/epih.e2021092    Published online Nov 2, 2021.
Association between early antenatal care and antenatal care contacts across low-and middle-income countries: effect modification by place of residence
Paschal Awingura Apanga1  , Maxwell Tii Kumbeni2 
1Department of Epidemiology, Biostatistics and Environmental Health, School of Public Health, University of Nevada, Reno, NV, USA
2Department of Health Management and Policy, College of Public Health and Human Sciences, Oregon State University, Corvallis, OR, USA
Correspondence  Paschal Awingura Apanga ,Email: awingura@yahoo.com
Received: Aug 3, 2021  Accepted after revision: Nov 2, 2021
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.
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.
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.
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.
Keywords: Early antenatal care, Antenatal contacts, Pregnancy, Residence, Low-and middle-income countries, Effect modification
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