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BMC Pregnancy and Childbirth
Published in: BMC Pregnancy and Childbirth 1/2020

01-12-2020 | Care | Research Article

Interventions to improve adherence to antenatal and postnatal care regimens among pregnant women in sub-Saharan Africa: a systematic review

Authors: Kristina Esopo, Lilly Derby, Johannes Haushofer

Published in: BMC Pregnancy and Childbirth | Issue 1/2020

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Abstract

Background

Pregnant women in sub-Saharan Africa tend to have low adherence to antenatal and postnatal care regimens, contributing to high infant and child mortality rates. Despite low adherence figures and the high returns from attending antenatal and postnatal care visits, research on interventions to improve adherence is in its infancy. Our aim was to determine the effectiveness of existing interventions to improve adherence to antenatal and postnatal care regimens among pregnant women in sub-Saharan Africa.

Methods

Full text, peer-reviewed articles, published in English and listed in PubMed or PsycINFO through January 2018 were identified in a systematic review. Studies were restricted to randomized controlled trials only and had to assess intervention impact on antenatal and postnatal care adherence, operationalized as the frequency of visits attended. Two reviewers independently screened papers for inclusion and evaluated the risk of systematic error in each study using the Cochrane risk of bias tool. Any discrepancies were reconciled by a third independent reviewer.

Results

The initial search generated 186 articles, of which, five met our inclusion criteria. Due to the small sample size and methodological variation across studies, a pooled effect size estimate could not be obtained. Therefore, effects on antenatal and postnatal care adherence were examined and reported at the individual study level. None of the interventions were directly aimed at improving adherence, but two of the five, both behavioral interventions, demonstrated effectiveness in increasing antenatal care (rate ratio 5.86, 95% CI 2.6-13.0, p<0.0001) and postnatal care adherence (31.3%, 95% CI 15.4-47.2, p=0.0009), respectively. Three home visit interventions had no effect on antenatal care adherence. Although the risk of bias was unclear or high in some cases, it remained low in most categories across studies.

Conclusions

Results point to a large gap in the literature on interventions to address antenatal and postnatal care adherence in sub-Saharan Africa. Interventions drawing upon the executive function literature and the promising results of the behavioral interventions reviewed here are urgently needed to address these gaps.

Trial registration

The review was prospectively registered with PROSPERO, id number https://​www.​crd.​york.​ac.​uk/​prospero/​display_​record.​php?​RecordID=​88152, on February 7, 2018.
Appendix
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Literature
1.
Hug L, Sharrow D, You D. Levels & trends in child mortality: report 2017. Technical report. United Nations Inter-agency Group for Child Mortality Estimation. 2017.
2.
World Health Organization W. World health statistics 2015. Technical report. World Health Organization. 2015.
3.
Darmstadt GL, Bhutta ZA, Cousens S, Adam T, Walker N, De Bernis L, Team LNSS, et al.Evidence-based, cost-effective interventions: how many newborn babies can we save?Lancet. 2005; 365(9463):977–88.
4.
Doku DT, Neupane S. Survival analysis of the association between antenatal care attendance and neonatal mortality in 57 low-and middle-income countries. Int J Epidemiol. 2017; 46(5):1668–77.CrossRef
5.
Arunda M, Emmelin A, Asamoah BO. Effectiveness of antenatal care services in reducing neonatal mortality in kenya: analysis of national survey data. Glob Health Action. 2017; 10(1):1328796.CrossRef
6.
World Health Organization W. Who recommendations on postnatal care of the mother and newborn. Technical report. World Health Organization. 2014.
7.
World Health Organization W. Who recommendations on antenatal care for a positive pregnancy experience. Technical report. World Health Organization. 2016.
8.
UNICEF. Unicef global databases, based on multiple indicator cluster surveys (mics), demographic and health surveys (dhs) and other nationally representative sources. Technical report. United Nations Children’s Fund. 2016.
9.
World Health Organization W. World health statistics 2014. Technical report. World Health Organization. 2014.
10.
Moher D, Liberati A, Tetzlaff J, Altman DG, Group P, et al.Preferred reporting items for systematic reviews and meta-analyses: the prisma statement. PLoS medicine. 2009; 6(7):1000097.CrossRef
11.
Esopo K, Derby L, Haushofer J. Interventions to improve adherence to antenatal and postnatal care regimens among pregnant women in sub-saharan africa: A systematic review. PROSPERO CRD42018088152. 2018.
12.
Wallace BC, Small K, Brodley CE, Lau J, Trikalinos TA. Deploying an interactive machine learning system in an evidence-based practice center: abstrackr. In: Proceedings of the 2nd ACM SIGHIT International Health Informatics Symposium. ACM: 2012. p. 819–24.
13.
Santos CMdC, Pimenta CAdM, Nobre MRC. The pico strategy for the research question construction and evidence search. Revista latino-americana de enfermagem. 2007; 15(3):508–11.CrossRef
14.
Wood L, Egger M, Gluud LL, Schulz KF, Jüni P, Altman DG, Gluud C, Martin RM, Wood AJ, Sterne JA. Empirical evidence of bias in treatment effect estimates in controlled trials with different interventions and outcomes: meta-epidemiological study. Bmj. 2008; 336(7644):601–5.CrossRef
15.
Higgins JP, Altman DG, Gøtzsche PC, Jüni P, Moher D, Oxman AD, Savović J, Schulz KF, Weeks L, Sterne JA. The cochrane collaborations tool for assessing risk of bias in randomised trials. Bmj. 2011; 343:5928.CrossRef
16.
Higgins JP, Altman DG. Assessing risk of bias in included studies. Cochrane handbook for systematic reviews of interventions: Cochrane book series. 2008:187–241.
17.
Ayiasi RM, Kolsteren P, Batwala V, Criel B, Orach CG. Effect of village health team home visits and mobile phone consultations on maternal and newborn care practices in masindi and kiryandongo, uganda: a community-intervention trial. PloS ONE. 2016; 11(4):0153051.
18.
Cherniak W, Anguyo G, Meaney C, Kong LY, Malhame I, Pace R, Sodhi S, Silverman M. Effectiveness of advertising availability of prenatal ultrasound on uptake of antenatal care in rural uganda: A cluster randomized trial. PloS ONE. 2017; 12(4):0175440.CrossRef
19.
Kirkwood BR, Manu A, ten Asbroek AH, Soremekun S, Weobong B, Gyan T, Danso S, Amenga-Etego S, Tawiah-Agyemang C, Owusu-Agyei S, et al.Effect of the newhints home-visits intervention on neonatal mortality rate and care practices in ghana: a cluster randomised controlled trial. Lancet. 2013; 381(9884):2184–92.CrossRef
20.
Magoma M, Requejo J, Campbell O, Cousens S, Merialdi M, Filippi V. The effectiveness of birth plans in increasing use of skilled care at delivery and postnatal care in rural tanzania: a cluster randomised trial. Trop Med Int Health. 2013; 18(4):435–43.CrossRef
21.
Waiswa P, Pariyo G, Kallander K, Akuze J, Namazzi G, Ekirapa-Kiracho E, Kerber K, Sengendo H, Aliganyira P, Lawn JE, et al.Effect of the uganda newborn study on care-seeking and care practices: a cluster-randomised controlled trial. Glob Health Act. 2015; 8(1):24584.CrossRef
22.
Higgs ES, Goldberg AB, Labrique AB, Cook SH, Schmid C, Cole CF, Obregón RA. Understanding the role of mhealth and other media interventions for behavior change to enhance child survival and development in low-and middle-income countries: an evidence review. J Health Commun. 2014; 19(sup1):164–89.CrossRef
23.
Lee SH, Nurmatov UB, Nwaru BI, Mukherjee M, Grant L, Pagliari C. Effectiveness of mhealth interventions for maternal, newborn and child health in low–and middle–income countries: Systematic review and meta–analysis. J Glob Health. 2016; 6(1).
24.
Watterson JL, Walsh J, Madeka I. Using mhealth to improve usage of antenatal care, postnatal care, and immunization: a systematic review of the literature. BioMed Res Int. 2015; 2015.
25.
Sondaal SFV, Browne JL, Amoakoh-Coleman M, Borgstein A, Miltenburg AS, Verwijs M, Klipstein-Grobusch K. Assessing the effect of mhealth interventions in improving maternal and neonatal care in low-and middle-income countries: a systematic review. PloS ONE. 2016; 11(5):0154664.CrossRef
26.
Brock LL, Brock CD, Thiedke CC. Executive function and medical non-adherence: a different perspective. Int J Psychiatry Med. 2011; 42(2):105–15.CrossRef
27.
Acharya D, Khanal V, Singh JK, Adhikari M, Gautam S. Impact of mass media on the utilization of antenatal care services among women of rural community in nepal. BMC Res Notes. 2015; 8(1):345.CrossRef
28.
Edward B. Factors influencing the utilisation of antenatal care content in uganda. Australas Med J. 2011; 4(9):516.CrossRef
29.
Ghosh D. Effect of mothers’ exposure to electronic mass media on knowledge and use of prenatal care services: a comparative analysis of indian states. Prof Geograph. 2006; 58(3):278–93.CrossRef
30.
Islam M, Odland J. Determinants of antenatal and postnatal care visits among indigenous people in bangladesh: a study of the mru community. Rural Remote Health. 2011; 11(2).
31.
Kulkarni M, Nimbalkar M. Influence of socio-demographic factors on the use of antenatal care. Ind J Prev Soc Med. 2008; 39(3):98–102.
32.
Mullainathan S, Shafir E. Scarcity: Why Having Too Little Means so Much: Macmillan; 2013.
33.
Gollwitzer PM, Sheeran P. Implementation intentions and goal achievement: A meta-analysis of effects and processes. Adv Exp Soc Psychol. 2006; 38:69–119.
34.
Milkman KL, Beshears J, Choi JJ, Laibson D, Madrian BC. Using implementation intentions prompts to enhance influenza vaccination rates. Proc Natl Acad Sci. 2011; 108(26):10415–20.CrossRef
35.
Gordis L. Conceptual and methodologic problems in measuring patient compliance. Compliance Health Care. 1979:23–45.
36.
Haynes RB, Taylor DW, Sackett DL, Gibson ES, Bernholz CD, Mukherjee J. Can simple clinical measurements detect patient noncompliance?Hypertension. 1980; 2(6):757–64.CrossRef
37.
Stephenson BJ, Rowe BH, Haynes RB, Macharia WM, Leon G. Is this patient taking the treatment as prescribed?JAMA. 1993; 269:2779.CrossRef
38.
Neupane S, Doku DT. Association of the quality of antenatal care with neonatal mortality: meta-analysis of individual participant data from 60 low-and middle-income countries. Int Health. 2019.
39.
Graham WJ, Varghese B. Quality, quality, quality: gaps in the continuum of care. Lancet. 2012; 379(9811):5–6.CrossRef
40.
Duysburgh E, Zhang W-H, Ye M, Williams A, Massawe S, Sié A, Williams J, Mpembeni R, Loukanova S, Temmerman M. Quality of antenatal and childbirth care in selected rural health facilities in burkina faso, ghana and tanzania: similar finding. Trop Med Int Health. 2013; 18(5):534–47.CrossRef
41.
Kyei NN, Chansa C, Gabrysch S. Quality of antenatal care in zambia: a national assessment. BMC Pregnancy Childbirth. 2012; 12(1):151.CrossRef
42.
Van Eijk AM, Bles HM, Odhiambo F, Ayisi JG, Blokland IE, Rosen DH, Adazu K, Slutsker L, Lindblade KA. Use of antenatal services and delivery care among women in rural western kenya: a community based survey. Reprod Health. 2006; 3(1):2.CrossRef
43.
Kanyangarara M, Munos MK, Walker N. Quality of antenatal care service provision in health facilities across sub–saharan africa: Evidence from nationally representative health facility assessments. J Glob Health. 2017; 7(2).
Metadata
Title
Interventions to improve adherence to antenatal and postnatal care regimens among pregnant women in sub-Saharan Africa: a systematic review
Authors
Kristina Esopo
Lilly Derby
Johannes Haushofer
Publication date
01-12-2020
Publisher
BioMed Central
Keyword
Care
Published in
BMC Pregnancy and Childbirth / Issue 1/2020
Electronic ISSN: 1471-2393
DOI
https://doi.org/10.1186/s12884-020-02992-y

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