Associations between Antenatal Care Visit Attendance and Infant Mortality and Growth

Aimee J. Lansdale Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, California

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Mamadou Bountogo Centre de Recherche en Santé de Nouna, Nouna, Burkina Faso

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Ali Sie Centre de Recherche en Santé de Nouna, Nouna, Burkina Faso

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Alphonse Zakane Centre de Recherche en Santé de Nouna, Nouna, Burkina Faso

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Guillaume Compaoré Centre de Recherche en Santé de Nouna, Nouna, Burkina Faso

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Thierry Ouedraogo Centre de Recherche en Santé de Nouna, Nouna, Burkina Faso

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Elodie Lebas Francis I Proctor Foundation, University of California, San Francisco, San Francisco, California

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Thomas Lietman Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, California
Francis I Proctor Foundation, University of California, San Francisco, San Francisco, California
Department of Ophthalmology, University of California, San Francisco, San Francisco, California

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Catherine E. Oldenburg Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, California
Francis I Proctor Foundation, University of California, San Francisco, San Francisco, California
Department of Ophthalmology, University of California, San Francisco, San Francisco, California

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This study examines the association between antenatal care (ANC) attendance and infant mortality and growth outcomes. The study used data from the Nouveux-nés et Azithromycine: une Innovation dans le Traitement des Enfants (NAITRE) trial conducted in Burkina Faso. This analysis included 21,795 neonates aged 8 to 27 days who were enrolled in the trial and had ANC data available. Infants were followed until 6 months of age. The analysis adjusted for potential confounders including infant’s sex, maternal age, education, urbanicity, geographic region, season (dry versus rainy), pregnancy type (singleton versus multiple), number of previous pregnancies, if the infant was breastfed, and if the facility had an onsite physician to account for level of care. We used logistic and linear regression models to evaluate the association between ANC visits and all-cause infant mortality and infant growth measurements at 6 months. There was no significant association between ANC visits and 6-month mortality. Higher ANC attendance was associated with improved growth outcomes in infants at 6 months of age. After adjusting for potential confounders, each additional ANC visit was associated with a 0.03 kg increase in mean weight, 0.07 cm increase in mean length, 0.04 SD increase in mean mid-upper-arm circumference, 0.04 SD increase in mean height-for-age, 0.04 SD mean weight-for-age, and 0.02 SD mean weight-for-length Z-scores. These mean differences were statistically significant (except for weight-for-length Z-scores) but may not be clinically meaningful. Further research is warranted to explore the relationship between ANC attendance and longer-term health outcomes among infants.

Author Notes

Financial support: The NAITRE study was funded by the Bill & Melinda Gates Foundation (OPP1187628). Azithromycin and matching placebo were donated by Pfizer, Inc. (New York, NY). The funders played no role in the design of the study, analysis of data, or the decision to publish.

Authors’ addresses: Aimee J. Lansdale, Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, CA, E-mail: aimee.lansdale@ucsf.edu. Mamadou Bountogo, Ali Sie, Alphonse Zakane, Guillaume Compaore, and Thierry Ouedraogo, Centre de Recherche en Santé de Nouna, Nouna, Burkina Faso, Nouna, Burkina Faso, E-mails: drbountogo@yahoo.fr, sieali@yahoo.fr, al_zakane@yahoo.fr, guidedeo@yahoo.fr, and andiyam_oued2004@yahoo.fr. Elodie Lebas, Francis I Proctor Foundation, University of California, San Francisco, San Francisco, CA, E-mail: elodie.lebas@ucsf.edu. Thomas Lietman, Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, CA; Francis I Proctor Foundation, University of California, San Francisco, San Francisco, CA; and Department of Ophthalmology, University of California, San Francisco, San Francisco, CA, E-mail: tom.lietman@ucsf.edu.

Address correspondence to Catherine E. Oldenburg, Francis I Proctor Foundation, Department of Epidemiology and Biostatistics, University of California, San Francisco, CA 94158. E-mail: catherine.oldenburg@ucsf.edu
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