ArticleBMC health services research2021
Out-of-pocket costs and time spent attending antenatal care services: a case study of pregnant women in selected rural communities in Zinder, Niger.
Article in BMC health services research, 2021. The graph could read no effect estimate from its abstract, so it casts no vote on the map. It is linked to trial NCT01832688 (Assessment of the Nutritional Status of Pregnant Women in Zinder, Niger and Optimization of Prenatal Care Services), which is not on this map. Cited by 9 papers.
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Assessment of the Nutritional Status of Pregnant Women in Zinder, Niger and Optimization of Prenatal Care Services
Who cites it
9 citing papers in PubMed, 13 citations in OpenAlex.
- Antenatal care utilisation among pregnant adolescents in urban Ghana: a qualitative study of individual, family and health system influences.BMC pregnancy and childbirth · 2026Article
- Assessing the costs of antenatal care in Eastern Ethiopia: implications for improving the free maternity services policy.Health policy and planning · 2026Article
- Determinants of Antenatal Care Utilization Among Reproductive Age Women in Somaliland Using Somaliland Health Demographic Survey 2020 Data.Women's health reports (New Rochelle, N.Y.) · 2025Article
- Article
- The economic costs of malaria in pregnancy: evidence from four sub-Saharan countries.Gates open research · 2023Article
- Determinants of utilization of malaria preventive measures during pregnancy among women aged 15 to 49 years in Kenya: an analysis of the Malaria Indicator Survey 2020.Malaria journal · 2022Article
- Factors impacting antenatal care utilization: a systematic review of 37 fragile and conflict-affected situations.Conflict and health · 2022Review
- Article
- Association Between Transport Cost Burden, Basic Health Care Provision Fund (BHCPF) Enrolment, And Completion of Four Or More Antenatal Care Visits Among Pregnant Women in Ilorin South Local Government Area, Kwara State, Nigeria: A Mixed-Methods Study.Nigerian medical journal : journal of the Nigeria Medical AssociationArticle
Corrections and comments
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Authors and funding
6 authors at 3 institutions in 2 countries.
Funding
Abstract
backgroundDespite an official policy of exemption from health care costs, pregnant women in Niger still face some out-of-pocket costs (OPC) in addition to time costs when they attend antenatal care (ANC) services. We aimed to: 1) assess the OPC for pregnant woman attending ANC, 2) estimate the time spent to attend ANC and the opportunity cost of that time, and 3) assess how OPC and time spent to attend ANC affected ANC attendance.
methodsData were obtained from a quasi-experimental descriptive study carried out in the region of Zinder, Niger, which compared pre- and post-intervention cohorts of pregnant women (n = 1736 women who reported attending ANC during their current pregnancy). An ANC attendance score was developed to describe the timing of ANC attendance in regard to the WHO recommendation of attending 4 ANC sessions. OPC and time spent were evaluated separately for associations with ANC attendance using Spearman correlations.
resultsThe mean (±SD) age of pregnant women was 25.0 ± 6.4 yr, 19.0% were ≤ 19 yr and 99.7% were in their second or third trimester of gestation at the time of the interview. Among those who were > 13 weeks and > 27 weeks of gestation, 4.0 and 74.4% had attended ANC during their first and second trimesters, respectively. The median (1st quartile (Q1), 3rd quartile (Q3)) ANC score was 0 (- 1, 0), reflecting that the majority of women failed to follow the WHO recommendation. More than half of the women (72.5%) experienced OPC related to ANC. The majority of women (> 80%) reported spending ~ 3 h for an ANC visit, including travel and waiting time. Time spent to attend ANC was not associated with ANC attendance score. Women who experienced OPC, and those who received iron folic acid (IFA) or long-lasting insecticide-treated bednets during an ANC visit, were more likely to have a higher ANC attendance score compared to those who did not.
conclusionOPC and time spent were not identified as barriers to ANC visits, and IFA and long-lasting insecticide-treated bednets distribution could be used to motivate pregnant women to attend ANC.
trial registrationThe NiMaNu project was registered at www.clinicaltrials.gov as NCT01832688 . Registered 16 April 2013.
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