(P10-073-24) Enhanced Quality of Nutrition Services During Antenatal Care Through Interventions to Improve Maternal Nutrition in Bangladesh, Burkina Faso, Ethiopia, and India

Objectives: Quality antenatal care (ANC) services are critical for maternal health and nutrition. Information on quality of nutrition interventions during ANC is scarce in low-and middle-income countries. Our study examined the effects of intensified maternal nutrition interventions during ANC on service readiness, provision of care, and client’s experience of care in Bangladesh (BD), Burkina Faso (BF), Ethiopia (ET), and India (IN). We also examined inter-relationships between the dimensions of ANC quality.

Methods: We conducted a secondary data analysis of maternal nutrition impact evaluation datasets from BD, BF, ET, and IN. Quality of ANC indices were calculated using information from health facility assessments, healthcare provider interviews, ANC observations, and client exit interviews. Indices were standardized into a 10-point scale for comparison across the dimensions of ANC quality across countries. Structural equation models were used to examine relationships between dimensions of ANC quality.

Results: Health facilities in all four countries had high service readiness in both intervention and control areas for basic amenities, equipment and supplies, medicines, commodities, and guidelines (mean scores 8 - 10 in BD and BF, 7 - 9 in ET, and 6 - 8 in IN). Scores for provision of care were low across countries, but higher in intervention compared to control areas in BD (5.2 vs. 2.9) and BF (5.6 vs. 4.8). While client satisfaction scores were high and similar between intervention and control areas in all countries (8.3-9.7), client experience scores were lower and differed between the two treatment areas in Bangladesh (8.2 vs 7.1 in intervention and control). The interventions had significant direct effects on service readiness in BD (β= 0.07), BF (β= 1.20), and ET (β= 1.0); on provision of care in BD (β= 2.27), BF (β= 1.27), and IN (β= 0.96); and on experience of care in BD. The intervention was indirectly associated with experience of care, through service readiness and provision of care in BD (β= 0.30), BF (β= 0.30), and IN (β= 0.68).

Conclusions: This study provides evidence on various dimensions of service quality which may be improved by interventions to strengthen nutrition services during ANC in diverse LMICs.

Funding Sources: Bill & Melinda Gates Foundation through Alive & Thrive (FHI 360)