Impact of group antenatal care (G-ANC) versus individual antenatal care (ANC) on quality of care, ANC attendance and facility-based delivery: A pragmatic cluster-randomized controlled trial in Kenya and Nigeria
Impact of group antenatal care (G-ANC) versus individual antenatal care (ANC) on quality of care, ANC attendance and facility-based delivery: A pragmatic cluster-randomized controlled trial in Kenya and Nigeria
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DOI：
10.1371/journal.pone.0222177
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发表时间：
2019-10-02
期刊：
影响因子：
3.7
通讯作者：
Smith, Jeffrey M.
中科院分区：
文献类型：
--
作者：
Grenier, Lindsay;Suhowatsky, Stephanie;Smith, Jeffrey M.
背景产前保健（ANC）的低质量和频率与较低的基于设施的分娩-一个关键的干预措施，以降低孕产妇和新生儿死亡率的吸收。我们实施组ANC（G-ANC），替代服务提供模式，在肯尼亚和尼日利亚，以评估其对质量和出勤率在ANC和摄取设施为基础的delivery.MethodsFrom 2016年10月至2018年1月，我们进行了一项设施为基础的，务实的，集群随机对照试验，每个国家有20个集群。我们在首次ANC访视期间招募了妊娠< 24周的女性，并在干预机构招募了同意参加G-ANC以代替常规个体ANC的女性。G-ANC模型包括五个每月2小时的临床评估会议以及结构化的妊娠特异性小组讨论和活动。护理质量被定义为接受八项具体的ANC干预措施。数据是通过设施记录和自我报告期间，以家庭为基础的产后调查。结果所有完成随访的妇女均纳入分析（尼日利亚：1018/1075例入组妇女[94.7%]，肯尼亚：826/1013 [81.5%]）。在尼日利亚，与对照组相比，干预组妇女更有可能在医院分娩（尼日利亚：76.7% [391/510] vs 54.1% [275/508]; aOR 2.30，CI 1.51-3.49）。在这两个国家，干预组的妇女比对照组的妇女更有可能接受高质量的ANC。（尼日利亚：aOR 5.8，CI 1.98-17.21，p < 0.001;肯尼亚：aOR 5.08，CI 2.31-11.16，p < 0.001）并参加至少4次ANC访视（尼日利亚：aOR 13.30，CI 7.69-22.99，p < 0.001;肯尼亚：aOR 7.12，CI 3.91-12.97，p < 0.001）。结论在尼日利亚，G-ANC与较高的机构分娩率相关，而与个体ANC相关的分娩率较低。在肯尼亚和尼日利亚，这与接受优质产前护理的妇女比例较高和产前护理就诊频率较高有关。
BackgroundLow quality and frequency of antenatal care (ANC) are associated with lower uptake of facility-based deliveries-a key intervention to reduce maternal and neonatal mortality. We implemented group ANC (G-ANC), an alternative service delivery model, in Kenya and Nigeria, to assess its impact on quality and attendance at ANC and uptake of facility-based delivery.MethodsFrom October 2016-January 2018, we conducted a facility-based, pragmatic, cluster-randomized controlled trial with 20 clusters per country. We recruited women < 24 weeks gestation during their first ANC visit and enrolled women at intervention facilities who agreed to attend G-ANC in lieu of routine individual ANC. The G-ANC model consisted of five monthly 2-hour meetings with clinical assessments alongside structured gestationally specific group discussions and activities. Quality of care was defined as receipt of eight specific ANC interventions. Data were obtained through facility records and self-report during a home-based postpartum survey. Analysis was by intention to treat.FindingsAll women who completed follow up are included in the analysis (Nigeria: 1018/1075 enrolled women [94.7%], Kenya: 826/1013 [81.5%]). In Nigeria women in the intervention arm were more likely to have a facility-based delivery compared to those in the control arm (Nigeria: 76.7% [391/510] versus 54.1% [275/508]; aOR 2.30, CI 1.51-3.49). In both countries women in the intervention arm were more likely than those in the control arm to receive quality ANC (Nigeria: aOR 5.8, CI 1.98-17.21, p < 0.001; Kenya: aOR 5.08, CI 2.31-11.16, p < 0.001) and to attend at least four ANC visits (Nigeria: aOR 13.30, CI 7.69-22.99, p < 0.001; Kenya: aOR 7.12, CI 3.91-12.97, p < 0.001).ConclusionsG-ANC was associated with higher facility-based delivery rates in Nigeria, where those rates associated with individual ANC were low. In both Kenya and Nigeria it was associated with a higher proportion of women receiving quality ANC and higher frequency of ANC visits.