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Aim <p>This study examined the determinants associated with fidelity to five selected antenatal care (ANC) components—based on the 2016 World Health Organization ANC policy—across states in Nigeria.</p> Methods <p>We conducted a cross-sectional study using a post-implementation sample, <i>n</i> = 1,495 women, who completed recommended eight visit ANC (8vANC), obtained from the 2021 Nigeria Multiple Indicator Cluster Survey data. Fidelity was measured as the proportion of women who cumulatively adhered to five selected ANC components—timing of first ANC visit, blood pressure measurement, tetanus vaccinations, urinalysis, and blood sample test. A binary outcome variable was generated as a fidelity index by creating a composite score from all the measures of the five components, which was categorized as ‘concordant’ and ‘partial/non-concordant’. We also used a multilevel modeling mixed effects logistic regression method for analysis and applied an implementation research approach to examine the associated determinants.</p> Results <p>Among women who completed 8vANC, 99.7% initiated their first ANC visit within 12 weeks of gestation. The rate of concordance with the five selected ANC components was 84.1%. Compared with maternal age of 15–19 years, women aged 35–39 years had higher odds of concordance (OR: 2.83, 95% CI: 1.05–7.60), whereas a parity of ≥ 4 children (OR: 0.26, 95% CI: 0.15–0.46) was associated with lower odds of concordance, compared with parity of one child. There was no statistically significant variation observed across the states.</p> Conclusion <p>Our findings show that, among women who completed 8vANC, the likelihood of fidelity to the selected ANC components is relatively high and homogenous across states in Nigeria. However, it is imperative that advocacy efforts be specifically directed towards multiparous women to ensure adherence to all policy recommendations. Further research is needed to evaluate the degree to which the state-level implementation of the policy may have also influenced adherence to the selected ANC components.</p>

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Assessing the determinants associated with fidelity to the 2016 world health organization antenatal care policy across states in Nigeria

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2025年7月21日

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  • Christiana Ikemeh,
  • Adedayo O. Adeyemi,
  • Leah M. Frerichs,
  • Christopher M. Shea,
  • Justin G. Trogdon

摘要

Aim

This study examined the determinants associated with fidelity to five selected antenatal care (ANC) components—based on the 2016 World Health Organization ANC policy—across states in Nigeria.

Methods

We conducted a cross-sectional study using a post-implementation sample, n = 1,495 women, who completed recommended eight visit ANC (8vANC), obtained from the 2021 Nigeria Multiple Indicator Cluster Survey data. Fidelity was measured as the proportion of women who cumulatively adhered to five selected ANC components—timing of first ANC visit, blood pressure measurement, tetanus vaccinations, urinalysis, and blood sample test. A binary outcome variable was generated as a fidelity index by creating a composite score from all the measures of the five components, which was categorized as ‘concordant’ and ‘partial/non-concordant’. We also used a multilevel modeling mixed effects logistic regression method for analysis and applied an implementation research approach to examine the associated determinants.

Results

Among women who completed 8vANC, 99.7% initiated their first ANC visit within 12 weeks of gestation. The rate of concordance with the five selected ANC components was 84.1%. Compared with maternal age of 15–19 years, women aged 35–39 years had higher odds of concordance (OR: 2.83, 95% CI: 1.05–7.60), whereas a parity of ≥ 4 children (OR: 0.26, 95% CI: 0.15–0.46) was associated with lower odds of concordance, compared with parity of one child. There was no statistically significant variation observed across the states.

Conclusion

Our findings show that, among women who completed 8vANC, the likelihood of fidelity to the selected ANC components is relatively high and homogenous across states in Nigeria. However, it is imperative that advocacy efforts be specifically directed towards multiparous women to ensure adherence to all policy recommendations. Further research is needed to evaluate the degree to which the state-level implementation of the policy may have also influenced adherence to the selected ANC components.