Department of Epidemiology, Biostatistics and Environmental Health, School of Public Health, University of Nevada, Reno, NV, USA.
Department of Health Management and Policy, College of Public Health and Human Sciences, Oregon State University, Corvallis, OR, USA.
Epidemiol Health. 2021;43:e2021092. doi: 10.4178/epih.e2021092. Epub 2021 Nov 2.
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.
在中低收入国家（LMICs），接受早期产前保健（ANC）和 8 次或更多次产前检查（ANC8+）之间的关系尚未得到很好的描述。也不清楚妇女居住地是否会改变早期 ANC 与 ANC8+之间的关联。我们的主要目的是评估早期 ANC 与 ANC8+之间的关系，并研究这种关系是否因居住地而改变。我们还估计了 LMICs 中 ANC8+的覆盖范围。
我们使用 2017 年至 2020 年在 30 个 LMICs 进行的多次指标群集调查，对 207388 名近期活产母亲的数据进行了分析。使用带有稳健方差的修正泊松回归来评估早期 ANC 与 ANC8+之间的关系，同时调整了国家、聚类、分层和抽样权重。居住地的效应修饰作用是在加性和乘法尺度上进行评估的。对所有国家的 ANC8+的流行率估计进行了荟萃分析。
ANC8+的总体流行率为 35.6%，范围从马达加斯加的 1.7%到白俄罗斯的 99.4%。早期 ANC 与 ANC8+呈正相关（调整后的流行率比 [aPR]，2.61；95%置信区间 [CI]，1.82 至 3.74）。在加性（交互的相对超额风险，0.39；95%CI，0.35 至 0.44）和乘法（aPR，1.78；95%CI，1.08 至 2.95）尺度上均有证据表明存在正的效应修饰作用。
许多 LMICs 可能尚未采用 2016 年世界卫生组织关于 ANC8+的指南。接受早期 ANC 与 ANC8+的可能性增加有关，特别是对于农村地区的妇女。
