1
|
Islam MJ, Zobair KM. Do timing and frequency of antenatal care make a difference in maternal micronutrient intake and breastfeeding practices? Insights from a multi-country study in South Asia. PLOS GLOBAL PUBLIC HEALTH 2024; 4:e0002993. [PMID: 38437199 PMCID: PMC10911624 DOI: 10.1371/journal.pgph.0002993] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/21/2023] [Accepted: 02/06/2024] [Indexed: 03/06/2024]
Abstract
Despite the established benefits of vitamins and minerals for maternal and neonatal health, global micronutrient deficiency remains a significant concern. As such, the World Health Organization advocates timely antenatal care (ANC) initiation and micronutrient supplementation for expectant mothers. This study investigates the association between ANC timing and frequency and maternal health behaviours, specifically iron-folic acid (IFA) intake, early breastfeeding initiation, and exclusive breastfeeding among married women in South Asia. By utilizing recent Demographic and Health Survey data, this study focuses on married women aged 15-49 in Bangladesh (N = 966), India (N = 89,472), and Pakistan (N = 1,005), specifically primiparous women with children aged 0-23 months living with the motherMultivariable analysis revealed that women receiving ≥4 ANC visits were more likely to consume IFA ≥90 days compared to those with fewer visits in Bangladesh (AOR: 1.85, 95% CI [1.30, 2.63]), India (AOR: 1.87, 95% CI [1.81, 1.94]), and Pakistan (AOR: 1.92, 95% CI [1.24, 2.97]). Women receiving first ANC in the second or third trimester were less likely to consume IFC for ≥90 days compared to those with first-trimester ANC. While the ANC timing did not significantly influence early breastfeeding initiation, ANC frequency was inversely associated with delayed initiation in all countries. Breastfeeding advice during ANC visits was significantly associated with reduced odds of delayed breastfeeding initiation. Neither ANC timing nor frequency significantly predicted exclusive breastfeeding, except for breastfeeding advice in India. This study highlights the importance of ANC in maternal and child health outcomes. ANC timing and frequency, along with breastfeeding advice during ANC, notably influence maternal IFA consumption and early breastfeeding initiation. These findings underscore the need for targeted interventions during ANC visits to enhance maternal and child health practices in low- and middle-income countries.
Collapse
Affiliation(s)
- Md Jahirul Islam
- Griffith Criminology Institute, Griffith University, Brisbane, Queensland, Australia
- Ministry of Public Administration, Bangladesh Secretariat, Dhaka, Bangladesh
| | - Khondker Mohammad Zobair
- Department of International Business and Asian Studies, Griffith University, Brisbane, Queensland, Australia
| |
Collapse
|
2
|
Xie X, Munos MK, Lama TP, Bryce E, Khatry SK, LeClerq SC, Katz J. Validation of maternal recall of number of antenatal care visits attended in rural Southern Nepal: a longitudinal cohort study. BMJ Open 2023; 13:e079029. [PMID: 38072474 PMCID: PMC10729047 DOI: 10.1136/bmjopen-2023-079029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2023] [Accepted: 11/23/2023] [Indexed: 12/18/2023] Open
Abstract
OBJECTIVES This study aimed to examine the validity of maternal recall of total number of antenatal care (ANC) visits during pregnancy and factors associated with the accuracy of maternal recall. DESIGN This was a longitudinal cohort study conducted from December 2018 through November 2020. SETTING Five government health posts in the Sarlahi district of Southern Nepal. PARTICIPANTS 402 pregnant women between ages 15 and 49 who presented for their first ANC visit at the study health posts. MAIN OUTCOMES The observed number of ANC visits (gold standard) and the reported number of ANC visits at the postpartum interview (maternal recall). RESULTS On average, women in the study who had a live birth attended 4.7 ANC visits. About 65% of them attended four or more ANC visits during pregnancy as recommended by the Nepal government, and 38.3% of maternal report matched the categorical ANC visits as observed by the gold standard. The individual validity was poor to moderate, with the highest area under the receiver operating characteristic curve (AUC) being 0.69 (95% CI: 0.65 to 0.74) in the 1-3 visits group. Population-level bias (as distinct from individual-level bias) was observed in the 1-3 visits and 4 visits groups, where 1-3 visits were under-reported (inflation factor (IF): 0.69) and 4 ANC visits were highly over-reported (IF: 2.12). The binary indicator ANC4+ (1-3 visits vs 4+ visits) showed better population-level validity (AUC: 0.69; IF: 1.17) compared with the categorical indicators (1-3 visits, 4 visits, 5-6 visits and more than 6 visits). Report accuracy was not associated with maternal characteristics but was related to ANC frequency. Women who attended more ANC visits were less likely to correctly report their total number of visits. CONCLUSION Maternal report of number of ANC visits during pregnancy may not be a valid indicator for measuring ANC coverage. Improvements are needed to measure the frequency of ANC visits.
Collapse
Affiliation(s)
- Xinyu Xie
- Department of International Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Melinda K Munos
- Department of International Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Tsering P Lama
- Department of International Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Emily Bryce
- Department of International Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Subarna K Khatry
- Department of International Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
- Nepal Nutrition Intervention Project Sarlahi, Lalitpur, Nepal
| | - Steven C LeClerq
- Department of International Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
- Nepal Nutrition Intervention Project Sarlahi, Lalitpur, Nepal
| | - Joanne Katz
- Department of International Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
| |
Collapse
|
3
|
Kim SS, Ashok S, Avula R, Mahapatra T, Gokhale P, Walton S, Heidkamp RA, Munos MK. Moderate Accuracy of Survey Responses about Infant and Young Child Feeding Counseling Reported by Mothers with Children Less than 1 Year of Age in India. J Nutr 2023; 153:1220-1230. [PMID: 36796483 DOI: 10.1016/j.tjnut.2023.02.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2022] [Revised: 02/03/2023] [Accepted: 02/09/2023] [Indexed: 02/16/2023] Open
Abstract
BACKGROUND Counseling on infant and young child feeding (IYCF) to support optimal breastfeeding and complementary feeding practices is an essential intervention, and accurate coverage data is needed to identify gaps and monitor progress. However, coverage information captured during household surveys has not yet been validated. OBJECTIVES We examined the validity of maternal reports of IYCF counseling received during community-based contacts and factors associated with reporting accuracy. METHODS Direct observations of home visits conducted by community workers in 40 villages in Bihar, India served as the "gold standard" to maternal reports of IYCF counseling received during 2-wk follow-up surveys (n = 444 mothers with children less than 1 y of age, interviews matched to direct observations). Individual-level validity was assessed by calculating sensitivity, specificity, and AUC. Population-level bias was measured using the inflation factor (IF). Multivariable regression models were used to examine factors associated with response accuracy. RESULTS Prevalence of IYCF counseling during home visits was very high (90.1%). Maternal report of any IYCF counseling received in the past 2 wk was moderate (AUC: 0.60; 95% CI: 0.52, 0.67), and population bias was low (IF = 0.90). However, the recall of specific counseling messages varied. Maternal report of any breastfeeding, exclusive breastfeeding, and dietary diversity messages had moderate validity (AUC > 0.60), but other child feeding messages had low individual validity. Child age, maternal age, maternal education, mental stress, and social desirability were associated with reporting accuracy of multiple indicators. CONCLUSIONS Validity of IYCF counseling coverage was moderate for several key indicators. IYCF counseling is an information-based intervention that may be received from various sources, and it may be challenging to achieve higher reporting accuracy over a longer recall period. We consider the modest validity results as positive and suggest that these coverage indicators may be useful for measuring coverage and tracking progress over time.
Collapse
Affiliation(s)
- Sunny S Kim
- Poverty, Health and Nutrition Division, International Food Policy Research Institute (IFPRI), Washington, DC, USA.
| | | | | | | | - Priya Gokhale
- CARE India Solutions for Sustainable Development, Bihar, India
| | - Shelley Walton
- Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Rebecca A Heidkamp
- Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Melinda K Munos
- Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
| |
Collapse
|
4
|
L-Thorne-Lyman A, Lama TP, Heidkamp RA, Manandhar P, Subedi S, Munos MK, Bryce E, Khatry SK, LeClerq SC, Katz J. Cognitive testing of questions about antenatal care and nutrition interventions in southern Nepal. Soc Sci Med 2022; 311:115318. [PMID: 36099684 PMCID: PMC9554791 DOI: 10.1016/j.socscimed.2022.115318] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2022] [Revised: 05/31/2022] [Accepted: 08/25/2022] [Indexed: 11/16/2022]
Abstract
Large scale surveys such as the Demographic and Health Surveys (DHS) are used to measure the coverage and quality of antenatal care (ANC)-related services. Studies have increasingly validated questions from these surveys, though few have explored respondent comprehension or associated thought processes. This study aimed to use cognitive testing and validation approaches to understand how survey respondents understand questions related to ANC-related nutrition services. The study was nested within a larger validation study in southern Nepal. Pregnant women's receipt of ANC related services was directly observed at five health posts followed by a recall interview at 6 months postpartum. A week later, a survey module was re-administered to 30 women containing 15 questions about receipt of ANC care and specifically nutrition-related services. Detailed probing was used to identify cognitive challenges related to comprehension, retrieval, judgement, and response. Respondents accurately recalled the four specific ANC visits recommended by the government of Nepal but those with more visits struggled to estimate the total number of ANC visits they had made. A number of terms including "antenatal care, "nutrition" and "breastfeeding" were challenging for many respondents to understand. Visits to private providers including for ultrasounds were inconsistently included in ANC visit counts suggesting that question wording could better specify the type of care. Many respondents over-estimated the number of iron folic acid (IFA) supplements taken during pregnancy, and recall was challenging. Calculations were based on estimating the number of months between first ANC visit to delivery, and only sometimes factored in missed tablets. Opportunities exist to improve questions to facilitate better comprehension by respondents through a combination of using local terms and explanations, reordering some questions, and adapting questions to better match respondents' approaches to estimating numeric responses.
Collapse
Affiliation(s)
- Andrew L-Thorne-Lyman
- Department of International Health, 615 N. Wolfe Street E2545, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, 21205, USA.
| | - Tsering Pema Lama
- Department of International Health, 615 N. Wolfe Street E2545, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, 21205, USA; Nepal Nutrition Intervention Project-Sarlahi, Kathmandu, Nepal.
| | - Rebecca A Heidkamp
- Department of International Health, 615 N. Wolfe Street E2545, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, 21205, USA.
| | - Porcia Manandhar
- Department of International Health, 615 N. Wolfe Street E2545, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, 21205, USA.
| | - Seema Subedi
- Department of International Health, 615 N. Wolfe Street E2545, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, 21205, USA.
| | - Melinda K Munos
- Department of International Health, 615 N. Wolfe Street E2545, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, 21205, USA.
| | - Emily Bryce
- Department of International Health, 615 N. Wolfe Street E2545, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, 21205, USA.
| | - Subarna K Khatry
- Department of International Health, 615 N. Wolfe Street E2545, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, 21205, USA; Nepal Nutrition Intervention Project-Sarlahi, Kathmandu, Nepal.
| | - Steven C LeClerq
- Department of International Health, 615 N. Wolfe Street E2545, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, 21205, USA; Nepal Nutrition Intervention Project-Sarlahi, Kathmandu, Nepal.
| | - Joanne Katz
- Department of International Health, 615 N. Wolfe Street E2545, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, 21205, USA.
| |
Collapse
|
5
|
Bryce E, Katz J, Heidkamp R, Lama TP, Khatry SK, LeClerq S, Munos M. Validation of maternal report of nutrition-related interventions and counselling during antenatal care in southern Nepal. MATERNAL & CHILD NUTRITION 2022; 18:e13303. [PMID: 34905808 PMCID: PMC8932699 DOI: 10.1111/mcn.13303] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/08/2021] [Revised: 10/26/2021] [Accepted: 11/10/2021] [Indexed: 04/30/2023]
Abstract
The delivery of nutrition-related interventions and counselling during antenatal care is critical for a healthy pregnancy for both mother and child. However, the accuracy of maternal reports of many of these services during household surveys has not yet been examined. Our objectives were to assess the validity of the maternal reports of 10 antenatal nutrition interventions, including counselling, and examine associates between maternal characteristics and accuracy. Maternal report of services received collected during a post-partum survey was compared to the gold standard, the direct observation of all women's antenatal care visits. Individual-level validity was assessed by calculating indicator sensitivity, specificity and area under the operating curve (AUC). The inflation factor (IF) measured population-level bias. For five indicators, the high true coverage limited our ability to assess the validity of the maternal reports. There were no indicators that had both high individual-level validity (AUC > 0.70) and low population bias (0.75 < IF < 1.25). Indicators with greater true coverage estimates had higher sensitivity and lower specificity estimates compared to those indicators with lower true coverage. There were no maternal characteristics associated with the accuracy of the report. Maternal report of antenatal nutrition-related interventions and counselling during household surveys was found to have variable validity across indicators. Additional research in settings with varying coverage levels should be considered to best inform antenatal care coverage measurement in household surveys.
Collapse
Affiliation(s)
- Emily Bryce
- Department of International HealthJohns Hopkins Bloomberg School of Public HealthBaltimoreMarylandUSA
| | - Joanne Katz
- Department of International HealthJohns Hopkins Bloomberg School of Public HealthBaltimoreMarylandUSA
| | - Rebecca Heidkamp
- Department of International HealthJohns Hopkins Bloomberg School of Public HealthBaltimoreMarylandUSA
| | - Tsering Pema Lama
- Department of International HealthJohns Hopkins Bloomberg School of Public HealthBaltimoreMarylandUSA
| | - Subarna K. Khatry
- Department of International HealthJohns Hopkins Bloomberg School of Public HealthBaltimoreMarylandUSA
- Nepal Nutrition Intervention Project, Sarlahi (NNIPS)KathmanduNepal
| | - Steve LeClerq
- Department of International HealthJohns Hopkins Bloomberg School of Public HealthBaltimoreMarylandUSA
- Nepal Nutrition Intervention Project, Sarlahi (NNIPS)KathmanduNepal
| | - Melinda Munos
- Department of International HealthJohns Hopkins Bloomberg School of Public HealthBaltimoreMarylandUSA
| |
Collapse
|