Nguyen Phuong H, Tran Lan M, Kachwaha Shivani, Sanghvi Tina, Mahmud Zeba, Zafimanjaka Maurice G, Walissa Tamirat, Ghosh Sebanti, Kim Sunny S
Nutrition, Diets, and Health Unit, International Food Policy Research Institute (IFPRI), Washington D.C., USA.
Hubert Department of Global Health, Emory University, Atlanta, Georgia, USA.
J Glob Health. 2025 Mar 14;15:04054. doi: 10.7189/jogh.15.04054.
Quality antenatal care (ANC) services are critical for maternal health and nutrition. Information on the quality of nutrition interventions during ANC is scarce in low- and middle-income countries. We examined the effects of intensified maternal nutrition interventions during ANC on service readiness, provision of care, and experience of care and assessed the inter-relationships between the dimensions of quality.
We used data from impact evaluations of maternal nutrition interventions in Bangladesh, Burkina Faso, Ethiopia, and India. We calculated the quality of nutrition services during ANC using information from health facility assessments, health care provider interviews, ANC observations, and client exit interviews. We used structural equation models to examine relationships between the dimensions of quality.
Health facilities in all four countries had a high service readiness component in terms of basic amenities, equipment and supplies, medicines and commodities, and guidelines (mean (x̄) = 8-10 in Bangladesh and Burkina Faso, x̄ = 7-9 in Ethiopia, and x̄ = 6-8 in India). Scores for provision of care were low across the countries but higher in intervention compared to control areas in Bangladesh (5.2 vs. 2.9) and Burkina Faso (5.6 vs. 4.8), but not significantly different in Ethiopia (range = 4.7-5.0) and India (range = 2.6-3.5). For experience of care, client satisfaction scores were high and similar between intervention and control areas in all countries (range = 8.3-9.7), but client experience scores were lower with statistically significant differences observed only in Bangladesh (x̄ = 8.2 in intervention vs. x̄ = 7.1 in control areas). The interventions had significant direct effects on service readiness in Bangladesh (β = 0.07), Burkina Faso (β = 1.20), and Ethiopia (β = 1.0), on the provision of care in Bangladesh (β = 2.27), Burkina Faso (β = 1.27), and India (β = 0.96), and experience of care in Bangladesh (β = 0.21).
In this study, we provided evidence on various dimensions of service quality that may be improved by interventions to strengthen nutrition services during ANC in diverse low- and middle-income countries.
优质的产前保健（ANC）服务对孕产妇健康和营养至关重要。在低收入和中等收入国家，关于ANC期间营养干预质量的信息匮乏。我们研究了ANC期间强化孕产妇营养干预对服务准备情况、护理提供以及护理体验的影响，并评估了质量维度之间的相互关系。
我们使用了来自孟加拉国、布基纳法索、埃塞俄比亚和印度孕产妇营养干预影响评估的数据。我们利用卫生设施评估、医疗保健提供者访谈、ANC观察以及服务对象出院访谈的信息来计算ANC期间营养服务的质量。我们使用结构方程模型来研究质量维度之间的关系。
在所有四个国家，卫生设施在基本设施、设备和用品、药品和商品以及指南方面都具有较高的服务准备程度（孟加拉国和布基纳法索的均值（x̄）=8 - 10，埃塞俄比亚的x̄=7 - 9，印度的x̄=6 - 8）。各国的护理提供得分较低，但在孟加拉国（5.2对2.9）和布基纳法索（5.6对4.8），干预地区的得分高于对照地区，而在埃塞俄比亚（范围=4.7 - 5.0）和印度（范围=2.6 - 3.5）差异不显著。对于护理体验，所有国家干预地区和对照地区的服务对象满意度得分都很高且相似（范围=8.3 - 9.7），但服务对象体验得分较低，仅在孟加拉国观察到统计学上的显著差异（干预地区x̄=8.
