Model selection procedure.

BackgroundAntenatal care (ANC) is one of the recommended interventions to reduce stillbirth, maternal, neonatal, and child mortality through early identification and management of pregnancy complications or pre-existing conditions. Although increasing number of ANC is a key priority of the 2016 WHO recommendations, ANC uptake in Low and Middle Income Countries (LMICs) is insufficient. Therefore, this study aimed to investigate factors associated with the number of ANC contacts in LMICs.MethodsData for the study were drawn from 59 recent Demographic and Health Surveys (DHS) conducted in LMICS. We included a total sample of 520,377 mothers who gave birth in the five years preceding the survey. A multilevel negative binomial regression model was applied to identify factors that may affect number of ANC. Adjusted incidence rate ratios (AIRR) with 95% Confidence Interval (CI) were reported to show association.ResultsThis study found that mothers and their partner with higher educational attainment, mothers aged >35 years, mothers who had decision making autonomy, mothers from female headed household, mothers from richer and richest household, mothers exposed to media, and residing in urban areas had significantly more ANC contacts. However, number of ANC contacts were significantly lower among mothers who initiated ANC after 12 weeks of gestation and perceived healthcare access to be a big problem.ConclusionOur results suggest that individual, household, and community-level factors were associated with number of ANC contacts among pregnant mothers in LMICs. Hence, local and international policymakers, and programmers should focus on improving community awareness about maternal health care services through mass media and outreach programs with especial emphasis on women’s and their partners educational attainment, rural mothers, women’s empowerment, and household socioeconomic status.背景：产前检查（Antenatal care, ANC）是通过早期识别与干预妊娠并发症或基础疾病，以降低死胎、孕产妇、新生儿及儿童死亡率的推荐干预措施之一。尽管2016年世界卫生组织（World Health Organization, WHO）将增加产前检查次数列为核心优先建议，但中低收入国家（Low and Middle Income Countries, LMICs）的产前检查覆盖率仍显不足。为此，本研究旨在探究中低收入国家中与产前检查次数相关的影响因素。 方法：本研究数据取自在中低收入国家开展的59项最新人口与健康调查（Demographic and Health Surveys, DHS）。最终纳入520377名在调查前5年内分娩的母亲作为研究样本。采用多层负二项回归模型识别影响产前检查次数的相关因素，报告校正发病比（Adjusted Incidence Rate Ratios, AIRR）及其95%置信区间（Confidence Interval, CI）以展示因素与结局的关联。 结果：本研究发现，受教育程度更高的母亲及其配偶、年龄超过35岁的母亲、拥有决策自主权的母亲、来自女性户主家庭的母亲、家庭经济状况处于富裕及最富裕层级的母亲、接触过媒体的母亲，以及居住于城市地区的母亲，其产前检查次数显著更多。然而，在妊娠12周后才首次开展产前检查，以及认为医疗服务可及性存在严重问题的母亲，其产前检查次数则显著更低。 结论：本研究结果表明，个体、家庭及社区层面的多种因素均与中低收入国家孕妇的产前检查次数显著相关。据此，国内外政策制定者与项目规划者应聚焦于通过大众媒体及外展项目提升社区对孕产妇保健服务的认知，尤其应重点关注提升女性及其配偶的教育水平、覆盖农村地区孕产妇服务、推进女性赋权，以及改善家庭社会经济地位。