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

Autoři: Lindsay Grenier aff001;  Stephanie Suhowatsky aff001;  Mark M. Kabue aff002;  Lisa M. Noguchi aff001;  Diwakar Mohan aff003;  Shalmali Radha Karnad aff004;  Brenda Onguti aff005;  Eunice Omanga aff006;  Anthony Gichangi aff006;  Jonesmus Wambua aff006;  Charles Waka aff006;  Jaiyeola Oyetunji aff007;  Jeffrey M. Smith aff008
Působiště autorů: Department of Maternal and Newborn Health, Jhpiego, Baltimore, MD, United States of America aff001;  Department of Monitoring, Evaluation and Research, Jhpiego, Baltimore, MD, United States of America aff002;  Global Epidemiology and Control, Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States of America aff003;  Global Programs, Jhpiego, Nairobi, Kenya aff004;  Innovations and Technical Leadership, Jhpiego, Nairobi, Kenya aff005;  Department of Monitoring, Evaluation, and Research, Jhpiego, Nairobi, Kenya aff006;  Global Programs, Jhpiego, Abuja, Nigeria aff007;  Technical Leadership Office, Jhpiego, Baltimore, MD, United States of America aff008
Vyšlo v časopise: PLoS ONE 14(10)
Kategorie: Research Article
doi: 10.1371/journal.pone.0222177



Low 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.


From 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.


All 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).


G-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.

Klíčová slova:

Antenatal care – Global health – Kenya – Labor and delivery – Neonatal care – Nigeria – Pregnancy – Quality of care


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2019 Číslo 10