Abstract
Abstract
Background
Pregnant and breastfeeding adolescent girls and young women (PBF AGYW) face an increased risk of adverse maternal and newborn outcomes. To address these challenges, the Uganda Ministry of Health piloted the group-antenatal/postnatal care differentiated service delivery (G-ANC/PNC DSD) model at 33 health facilities and later expanded it to 685 facilities nationally. We assessed the uptake of the model, its cost and effect on utilization of maternal and child health (MCH) services among PBF AGYW.
Methods
We performed a retrospective review and analysis of data abstracted from records of PBF AGYW enrolling in ANC between July 1, 2021, through December 31, 2023. A total of 144 health facilities were selected: 72 implementing the G-ANC/PNC DSD model (intervention) and 72 providing standard ANC/PNC care (control). Uptake of the model was measured as the percentage of all AGYW attending the first ANC visit in the 72 intervention facilities. To assess the effectiveness of the model, 7,514 AGYWs were included in the analysis (intervention 3,861 and control 3,653). A modified Poisson regression model within a Generalized Estimating Equation framework was used. Measures were summarized using adjusted prevalence ratios (aPR) with 95% confidence intervals (CI). A retrospective cost analysis was performed using quantitative resource utilization data and qualitative insights at 25 intervention facilities.
Results
The overall uptake of the model was 34%. Attendance of 4 + ANC visits was higher in the intervention group (60.3%) (aPR = 1.93, 95% CI: 1.83–2.03). AGYW who enrolled in the model were more likely to retest for HIV during pregnancy (aPR = 2.30, 95% CI: 2.07–2.55); deliver at the health facility of ANC1 attendance (aPR = 2.47, 95% CI 2. 30 -2.65); attend PNC at 6 weeks (aPR = 4.61; 95% CI: 4.07–5.22); attend PNC at 6 months (aPR = 3.13; 95% CI: 2.65–3.69); and use modern post-partum contraceptive methods (aPR = 3.81; 95% CI: 3.26–4.44). The unit cost per G-ANC/PNC DSD model beneficiary was estimated at US $2.70.
Conclusion
Although the uptake was low, our results show that the model was associated with improved utilization of MCH services among AGYW. National programs may consider integrating G-ANC/PNC into MCH health education sessions to improve uptake during scale up.