ArticlePLOS global public health2023
More is not enough: High quantity and high quality antenatal care are both needed to prevent low birthweight in South Asia.
Article in PLOS global public health, 2023. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 15 papers, 1 of them a synthesis that pooled it.
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Who cites it
15 citing papers in PubMed, 1 synthesis or guideline pooled it, 19 citations in OpenAlex.
- Maternal and neonatal health service access and utilisation in sub-Saharan Africa (2015-2023): a systematic review and meta-analysis.BMC health services research · 2026Pooled it
- Placental Pathology in preeclampsia and gestational hypertension; A comparative study.Pakistan journal of medical sciences · 2026Article
- Prevalence and risk factors of low birth weight in a rural district of Bangladesh: a prospective cohort study.BMC pediatrics · 2026Article
- Article
- From visit counts to quality care: A qualitative study on early implementation of a new model for antenatal care in Kavre district, Nepal.PLOS global public health · 2026Article
- Predictors of antenatal care utilization among the Rohingya population in the refugee camps of Cox's Bazar, Bangladesh.Conflict and health · 2025Article
- Antenatal care quality and pregnancy outcomes in the northern region of Ghana: a mixed-methods analysis.BMC pregnancy and childbirth · 2025Article
- Using routine data to examine factors associated with stillbirth in three tertiary maternity facilities in Kabul, Afghanistan.Reproductive health · 2025Article
- Deep learning for causal inference using low birth weight in midwife-led continuity care intervention in north Shoa zone, Ethiopia.Frontiers in artificial intelligence · 2025Article
- Enhancing birth weight outcomes through improved antenatal care in West African countries: Evidence from propensity score matching analysis.PLOS global public health · 2025Article
- Decentralizing and task sharing within the primary health system improved access and quality of ANC services in Amhara and Oromia regions: pre-post health facility data.BMC primary care · 2024Article
- Geographical variation, socioeconomic inequalities of low birth weight, and its relationship with maternal dietary diversity: Insights from the maternal infant and young child nutrition programme in Bangladesh.Journal of global health · 2024Article
- Using formative research to enhance our understanding of implementation contexts: Preparing for a trial of maternal nutrition interventions.Maternal & child nutrition · 2024Article
- Synergistic associations of antenatal care visits and iron-folic acid supplementation with low birth weight: a pooled analysis of national surveys from six south Asian countries.BMC public health · 2024Article
- Contents of antenatal care services in Afghanistan: findings from the national health survey 2018.BMC public health · 2023Article
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Authors and funding
6 authors at 3 institutions in 2 countries.
Funding
No grant is acknowledged in the PubMed record.
Abstract
Antenatal care (ANC) is an opportunity to receive interventions that can prevent low birth weight (LBW). We sought to 1) estimate LBW prevalence and burden in South Asia, 2) describe the number of ANC visits (quantity) and interventions received (quality), and 3) explore associations between ANC quantity, quality and LBW. We used Demographic and Health Survey (DHS) data from Afghanistan (2015), Bangladesh (2018), India (2016), Nepal (2016), Pakistan (2018) and Sri Lanka (2016) (n = 146,284 children <5y). Women were categorized as follows: 1) low quantity (<4 ANC visits) and low quality (<5 of 10 interventions received during ANC), 2) low quantity and high quality (≥5 of 10 interventions), 3) high quantity (≥4 visits) and low quality, 4) high quantity and high quality. We used fixed effect logistic regressions to examine associations between ANC quality/quantity and LBW (<2500 grams). LBW prevalence was highest in Pakistan (23%) and India (18%), with India accounting for two-thirds of the regional burden. Only 8% of women in Afghanistan received high quantity and high quality ANC, compared to 42-46% in Bangladesh, India, and Pakistan, 65% in Nepal and 92% in Sri Lanka. Compared to the low quantity/quality reference group, children of women with high quantity/quality ANC had lower odds of LBW in India (Adjusted Odds Ratio 0.84, 95% CI 0.78-0.89), Nepal (0.57, 0.35-0.94), Pakistan (0.45, 0.23-0.86), and Sri Lanka (0.73, 0.57-0.92). Low quantity but high quality ANC was protective in India (0.90, 0.84-0.96), Afghanistan (0.53, 0.27-1.05) and Pakistan (0.49, 0.23-1.05). High quantity but low quality ANC was protective in Sri Lanka (0.76, 0.61-0.93). Neither frequent ANC without appropriate interventions nor infrequent ANC with appropriate interventions are sufficient to prevent LBW in most South Asian countries, though quality may be more important than quantity. Consistent measurement of interventions during ANC is needed.
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