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Abstract：
Maternal health is a global public health concern. The paucity of antenatal care (ANC) during pregnancy is directly associated with maternal mortality. This study assessed the individual and community-level determinants of quality ANC in six South-Asian countries. Data were obtained from a Demographic health survey of six South-Asian countries. This study included a sample of 180,567 (weighted) women aged 15-49 who had given birth in the preceding three years prior to the survey. The quality of ANC was determined by assessing whether a woman had received blood pressure monitoring, urine and blood sample screening, and iron supplements at any ANC visits. Frequency, percentage distribution, and inferential analysis (multilevel mixed-effects model) were conducted. The proportion of quality antenatal care utilization in South Asia was 66.9%. The multilevel analysis showed that women aged 35-49 years (AOR = 1.16; 95% CI = 1.09-1.24), higher education (AOR = 2.84; 95% CI = 2.69-2.99), middle wealth status (AOR = 1.55; 95% CI = 1.49-1.62), richest wealth status (AOR = 3.21; 95% CI = 3.04-3.39), unwanted pregnancy (AOR = 0.92; 95% CI = 0.89-0.95) and 2-4 birth order (AOR = 0.86; 95% CI = 0.83-0.89) were among the individual-level factors that were significantly associated with quality ANC utilization. In addition, rural residence (AOR = 0.77; 95% CI = 0.74-0.8), and big problem - distance to health facility (AOR = 0.63; 95% CI: 0.53-0.76) were the among community level factors there were also significantly associated with use of quality ANC. Meanwhile, women who lived in India (AOR: 22.57; 95% CI: 20.32-25.08) and Maldives (AOR: 33.33; 95% CI: 31.06-35.76) had higher odds of quality ANC than those lived in Afghanistan. Educational status, wealth status, pregnancy wantedness, sex of household head, birth order, place of residence, and distance to health facility were associated with quality ANC. Improving educational status, improving wealth status, reducing the distance to health facilities, and providing rural area-friendly interventions are important to increase the quality of ANC in South Asia.
摘要：
孕产妇健康是全球公共卫生关注的问题。怀孕期间缺乏产前护理（ANC）与孕产妇死亡率直接相关。这项研究评估了六个南亚国家质量ANC的个人和社区水平决定因素。数据来自对六个南亚国家的人口健康调查。这项研究包括180,567名（加权）15-49岁女性的样本，这些女性在调查前三年内分娩。ANC的质量是通过评估一名妇女是否接受了血压监测来确定的，尿液和血液样本筛查，和铁质补充剂在任何ANC访问。频率,百分比分布，并进行了推理分析(多层次混合效应模型)。南亚优质产前保健利用比例为66.9%。多水平分析显示,35-49岁女性(AOR=1.16;95%CI=1.09-1.24),高等教育(AOR=2.84；95%CI=2.69-2.99)，中等财富状况(AOR=1.55；95%CI=1.49-1.62)，最富有的财富地位(AOR=3.21；95%CI=3.04-3.39)，意外妊娠(AOR=0.92;95%CI=0.89-0.95)和2-4次出生顺序(AOR=0.86;95%CI=0.83-0.89)是与ANC利用质量显著相关的个体水平因素.此外,农村住宅(AOR=0.77；95%CI=0.74-0.8)，和大问题-距离医疗机构（AOR=0.63;95％CI：0.53-0.76）是社区水平因素中也与使用优质ANC显着相关。同时,生活在印度(AOR:22.57;95%CI:20.32-25.08)和马尔代夫(AOR:33.33;95%CI:31.06-35.76)的女性获得高质量ANC的几率高于生活在阿富汗的女性。教育状况,财富地位,怀孕渴望，户主的性别，出生顺序,居住地,与医疗机构的距离与ANC质量相关。提高教育水平，提高财富地位，缩短与医疗设施的距离，提供农村地区友好的干预措施对于提高南亚非国大的质量很重要。
