Improved antenatal care services in rural Ethiopia's public health centers through the Enhancing Nutrition and Antenatal Infection Treatment (ENAT) intervention.

backgroundAntenatal care (ANC) in Ethiopia faces quality and content gaps. The Enhancing Nutrition and Antenatal Infection Treatment (ENAT) intervention was designed to improve ANC services in public health facilities by strengthening infection diagnosis, training healthcare providers, supplying equipment, and enhancing counseling. We assessed ENAT's association with improved ANC outcomes, including testing (blood/urine), infection prevention, nutrition supplementation, counseling, and visit adherence.

methodsA quasi-experimental design (QED) was used, with baseline data collected in December 2020 and endline in January 2023 from intervention and comparison areas. We interviewed women who were pregnant within two years preceding the surveys: baseline (comparison = 631, intervention = 705) and endline (comparison = 638, intervention = 719). We examined the association between the intervention and ANC outcomes using Difference-in-Differences (DiD) logit models.

resultsThe ENAT intervention showed statistically significant improvements in blood sample testing during pregnancy (DiD: +8%, β = 1.03, p < 0.001), while urine testing demonstrated a marginally significant association (DiD: +7%, β = 0.60, p = 0.057). Notable positive improvements were observed in the administration of iron folate (DiD, + 11%, β = 1.21, p < 0.001), tetanus toxoid injections (DiD, + 10%, β = 0.61, p = 0.042), and deworming tablets (DiD, + 20%, β = 0.65, p = 0.032). Statistically significant improvements were also seen in counseling on nutrition (DiD, + 11%, β = 0.59, p = 0.001) and pregnancy complications (DiD, + 9%, β = 0.34, p = 0.038). Although four or more ANC visits saw a statistically significant increase in the intervention area (DiD: +9%, β = 1.24, p = 0.049), 38% of women remained below this benchmark. Furthermore, the intervention did not significantly improve the timing of the first ANC visit (DiD, + 5%, β = 0.017, p = 0.928), with only half of the women initiating ANC in the first trimester.

conclusionThe ENAT intervention improved ANC service contents, quality, and visit frequency while enhancing key counseling topics. These findings demonstrate targeted interventions' potential to strengthen ANC in resource-limited settings. However, early ANC initiation remains challenging, with many women not completing the recommended four or more visits. Future programs should address barriers to timely ANC initiation and completion.