ArticleJournal of healthcare leadership2026
Nurse-Led Antenatal Care in Conflict-Affected Yemen: A Prospective Cohort Study with Difference-in-Differences Analysis.
Article in Journal of healthcare leadership, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
Background: The growth of nurse-delivered care is often required in unstable and conflict-affected health systems due to physician shortages. Nevertheless, there is still a lack of research on the potential benefits of organized nurse-led prenatal care (ANC) in these kinds of environments. We evaluated the clinical outcomes and implementation characteristics associated with a protocol-driven nurse-led ANC model in conflict-affected Yemen. Methods: We conducted a prospective cohort study across 12 public primary healthcare facilities in Al-Dhalea, Yemen. Pregnant women aged 15-49 years with a gestational age of ≤ 20 weeks were enrolled in structured nurse-led ANC (n = 224) or routine ANC (n = 226) according to facility capacity. Primary outcomes included follow-up hemoglobin levels and anemia (Hb < 11 g/dL). Secondary outcomes included low birth weight, preterm birth, and NICU admission. Multivariable regression, propensity score matching, difference-in-differences, mediation, and E-value analyses were performed. Results: Follow-up was completed for 435 women (96.7%). Nurse-led ANC was associated with higher follow-up hemoglobin (adjusted β = +1.05 g/dL, 95% CI 0.82 to 1.28), lower odds of anemia (adjusted OR = 0.32, 95% CI 0.21 to 0.48), and reduced low birth weight (adjusted OR = 0.62, 95% CI 0.41 to 0.94). The difference-in-differences estimator was +1.12 g/dL (p < 0.001), with parallel trends satisfied (p = 0.42). E-value analysis (2.41) suggested robustness to unmeasured confounding. The model demonstrated characteristics consistent with adaptive nursing leadership across clinical, administrative, and community dimensions. Conclusion: Structured nurse-led prenatal care has been linked to better outcomes for mothers and newborns in Yemen affected by war. These results encourage funding for workforce resilience and nurse-led approaches in order to enhance the health system in humanitarian contexts. To prove causation, more studies using cluster-randomized designs are required.
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