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Abstract：
BACKGROUND: Antenatal care (ANC) is essential for ensuring the well-being of pregnant women and their fetuses. This study models the association between achieving adequate ANC and various health and health-seeking indicators across wealth quintiles in low- and middle-income countries (LMICs).
RESULTS: We analyzed data from 638,265 women across 47 LMICs using available Demographic and Health Surveys from 2010 to 2022. Via multilevel logistic regression analyses adjusted for a series of confounding variables and country and wealth quintile fixed effects, we estimated the projected impact of achieving adequate ANC utilization and quality on a series of health and health care indicators: facility birth, postnatal care, childhood immunizations, and childhood stunting and wasting. Achieving adequate levels of ANC utilization and quality (defined as at least 4 visits, blood pressure monitoring, and blood and urine testing) was positively associated with health-seeking behavior across the majority of countries. The strongest association was observed for facility birth, followed by postnatal care and child immunization. The strength of the associations varied across countries and wealth quintiles, with more significant ones observed in countries with lower baseline ANC utilization levels and among the lower wealth quintiles. The associations of ANC with childhood stunting and wasting were notably less statistically significant compared to other indicators. Despite rigorous adjustments for potential confounders, a limitation to the methodology is that it is possible that unobserved variables may still impact outcomes.
CONCLUSIONS: Strengthening ANC is associated with improved use of other health care in LMICs. ANC could serve as a critical platform for improving health outcomes for mothers and their children, emphasizing its importance beyond direct impact on maternal and neonatal mortality.
RESULTS: We analyzed data from 638,265 women across 47 LMICs using available Demographic and Health Surveys from 2010 to 2022. Via multilevel logistic regression analyses adjusted for a series of confounding variables and country and wealth quintile fixed effects, we estimated the projected impact of achieving adequate ANC utilization and quality on a series of health and health care indicators: facility birth, postnatal care, childhood immunizations, and childhood stunting and wasting. Achieving adequate levels of ANC utilization and quality (defined as at least 4 visits, blood pressure monitoring, and blood and urine testing) was positively associated with health-seeking behavior across the majority of countries. The strongest association was observed for facility birth, followed by postnatal care and child immunization. The strength of the associations varied across countries and wealth quintiles, with more significant ones observed in countries with lower baseline ANC utilization levels and among the lower wealth quintiles. The associations of ANC with childhood stunting and wasting were notably less statistically significant compared to other indicators. Despite rigorous adjustments for potential confounders, a limitation to the methodology is that it is possible that unobserved variables may still impact outcomes.
CONCLUSIONS: Strengthening ANC is associated with improved use of other health care in LMICs. ANC could serve as a critical platform for improving health outcomes for mothers and their children, emphasizing its importance beyond direct impact on maternal and neonatal mortality.
摘要：
背景：产前护理（ANC）对于确保孕妇及其胎儿的健康至关重要。这项研究模拟了在低收入和中等收入国家（LMICs）的财富五分位数中实现适当的ANC与各种健康和寻求健康指标之间的关联。
结果：我们使用2010年至2022年的人口和健康调查分析了来自47个LMIC的638,265名女性的数据。通过对一系列混杂变量以及国家和财富五分位数固定效应进行调整的多水平逻辑回归分析，我们估计了实现适当的ANC利用率和质量对一系列健康和医疗保健指标的预期影响：设施出生，产后护理，儿童免疫接种，童年发育迟缓和消瘦。达到适当的ANC利用率和质量水平(定义为至少4次访问，血压监测,以及血液和尿液检测）与大多数国家的寻求健康行为呈正相关。在设施出生方面观察到最强的关联，其次是产后护理和儿童免疫接种。协会的力量因国家和财富五分之一而异，在基线ANC利用水平较低的国家和财富五分位数较低的国家中观察到更重要的国家。与其他指标相比，ANC与儿童期发育迟缓和消瘦的关联在统计学上明显较低。尽管对潜在的混杂因素进行了严格的调整，该方法的局限性在于,未观察到的变量可能仍会影响结果.
结论：加强ANC与改善LMIC中其他医疗保健的使用有关。ANC可以作为改善母亲及其子女健康结果的重要平台，强调其重要性，而不仅仅是对孕产妇和新生儿死亡率的直接影响。
结果：我们使用2010年至2022年的人口和健康调查分析了来自47个LMIC的638,265名女性的数据。通过对一系列混杂变量以及国家和财富五分位数固定效应进行调整的多水平逻辑回归分析，我们估计了实现适当的ANC利用率和质量对一系列健康和医疗保健指标的预期影响：设施出生，产后护理，儿童免疫接种，童年发育迟缓和消瘦。达到适当的ANC利用率和质量水平(定义为至少4次访问，血压监测,以及血液和尿液检测）与大多数国家的寻求健康行为呈正相关。在设施出生方面观察到最强的关联，其次是产后护理和儿童免疫接种。协会的力量因国家和财富五分之一而异，在基线ANC利用水平较低的国家和财富五分位数较低的国家中观察到更重要的国家。与其他指标相比，ANC与儿童期发育迟缓和消瘦的关联在统计学上明显较低。尽管对潜在的混杂因素进行了严格的调整，该方法的局限性在于,未观察到的变量可能仍会影响结果.
结论：加强ANC与改善LMIC中其他医疗保健的使用有关。ANC可以作为改善母亲及其子女健康结果的重要平台，强调其重要性，而不仅仅是对孕产妇和新生儿死亡率的直接影响。
