title: Do antenatal care interventions improve neonatal survival in India?
abstract: Although antenatal care (ANC) interventions have been in place for a long time, there is hardly any systematic evidence on the association between ANC interventions and neonatal mortality in India. The present study attempts to investigate the association between ANC interventions and neonatal mortality in India using data from the District Level Household Survey conducted in India during 2007-8. The ANC interventions included in the analysis are at least four antenatal visits, consumption of 90 or more iron-folic acid (IFA) tablets, and uptake of two or more tetanus toxoid (TT) injections. We have used discrete-time logistic regression models to investigate the association between ANC interventions and neonatal mortality. Risk of neonatal mortality was significantly lower for infants of mothers who availed four or more antenatal visits [odds ratio (OR): 0.69; 95% confidence interval (CI): 0.60-0.81], consumed 90 or more IFA tablets (OR: 0.85; 95% CI: 0.73-0.99), received two or more TT injections (OR: 0.73; 95% CI: 0.63-0.83). When we analysed different combinations of antenatal visits, IFA supplementation and TT injections, TT injections provided the main protective effect-the risk of neonatal mortality was significantly lower in newborns of women who received two or more TT injections but did not consume 90 or more IFA tablets (OR: 0.69; 95% CI: 0.60-0.78), or who received two or more TT injections but did not avail four or more antenatal visits (OR: 0.75; 95% CI: 0.66-0.86). In the statistical model, 6% (95% CI: 4-8%) of the neonatal deaths in India could be attributed to a lack of at least two TT injections during pregnancy. Indian public health programmes must ensure that every pregnant woman receives two or more TT injections during antenatal visits.
authors.affiliation: Department of Public Health & Mortality Studies, International Institute for Population Sciences, Mumbai 400 088, India, Global Health and Social Care Unit, School of Health Sciences & Social Work, University of Portsmouth, Portsmouth PO1 2FR, UK, Director & Senior Professor, International Institute for Population Sciences, Mumbai 400 088, India and Department of Development Studies, International Institute for Population Sciences, Mumbai 400 088, India abhi_iips@yahoo.co.in.
authors.forename: Abhishek
authors.initials: A
authors.lastname: Singh
authors.affiliation: Department of Public Health & Mortality Studies, International Institute for Population Sciences, Mumbai 400 088, India, Global Health and Social Care Unit, School of Health Sciences & Social Work, University of Portsmouth, Portsmouth PO1 2FR, UK, Director & Senior Professor, International Institute for Population Sciences, Mumbai 400 088, India and Department of Development Studies, International Institute for Population Sciences, Mumbai 400 088, India.
authors.forename: Saseendran
authors.initials: S
authors.lastname: Pallikadavath
authors.affiliation: Department of Public Health & Mortality Studies, International Institute for Population Sciences, Mumbai 400 088, India, Global Health and Social Care Unit, School of Health Sciences & Social Work, University of Portsmouth, Portsmouth PO1 2FR, UK, Director & Senior Professor, International Institute for Population Sciences, Mumbai 400 088, India and Department of Development Studies, International Institute for Population Sciences, Mumbai 400 088, India.
authors.forename: Faujdar
authors.initials: F
authors.lastname: Ram
authors.affiliation: Department of Public Health & Mortality Studies, International Institute for Population Sciences, Mumbai 400 088, India, Global Health and Social Care Unit, School of Health Sciences & Social Work, University of Portsmouth, Portsmouth PO1 2FR, UK, Director & Senior Professor, International Institute for Population Sciences, Mumbai 400 088, India and Department of Development Studies, International Institute for Population Sciences, Mumbai 400 088, India.
authors.forename: Manoj
authors.initials: M
authors.lastname: Alagarajan
mesh_terms: D000328:Adult; D019587:Dietary Supplements / Q000706:statistics & numerical data; D005260:Female; D005492:Folic Acid / Q000627:therapeutic use; D006306:Health Surveys; D006801:Humans; D007194:India / Q000453:epidemiology; D007223:Infant; D007226:Infant Mortality; D007231:Infant, Newborn; D058085:Iron Compounds / Q000627:therapeutic use; D016015:Logistic Models; D008297:Male; D011247:Pregnancy; D011295:Prenatal Care / Q000706:statistics & numerical data; D013745:Tetanus Toxoid / Q000627:therapeutic use; D055815:Young Adult
chemical_list: D058085:Iron Compounds; D013745:Tetanus Toxoid; D005492:Folic Acid
keywords: Antenatal visits; India; discrete-time logistic regression model; iron–folic acid supplementation; neonatal mortality; tetanus toxoid injections
references.citation: Bull World Health Organ. 2010 Jul 1;88(7):500-8
references.pmid: 20616969
references.citation: Am J Obstet Gynecol. 2006 Feb;194(2):512-9
references.pmid: 16458655
references.citation: Indian Pediatr. 1988 Feb;25(2):167-9
references.pmid: 3246396
references.citation: Lancet. 2010 Feb 6;375(9713):490-9
references.pmid: 20071021
references.citation: Lancet. 2007 Dec 8;370(9603):1947-59
references.pmid: 17854885
references.citation: Indian Pediatr. 1997 Sep;34(9):785-92
references.pmid: 9492416
references.citation: PLoS One. 2012;7(9):e44931
references.pmid: 23028688
references.citation: BMJ. 2005 Nov 12;331(7525):1107
references.pmid: 16282407
references.citation: Bull World Health Organ. 2006 Sep;84(9):699-705
references.pmid: 17128339
references.citation: BMC Pregnancy Childbirth. 2011 Feb 11;11:13
references.pmid: 21314944
references.citation: Bull World Health Organ. 2006 Sep;84(9):706-13
references.pmid: 17128340
references.citation: Braz J Med Biol Res. 2007 Sep;40(9):1195-202
references.pmid: 17713666
references.citation: Popul Stud (Camb). 2012 Nov;66(3):223-39
references.pmid: 22783949
references.citation: Lancet. 2005 Mar 5-11;365(9462):891-900
references.pmid: 15752534
references.citation: Soc Sci Med. 2004 Sep;59(6):1147-58
references.pmid: 15210087
references.citation: Int J Gynaecol Obstet. 2000 Dec;71(3):209-10
references.pmid: 11102603
references.citation: Acta Obstet Gynecol Scand. 1997 Jan;76(1):1-14
references.pmid: 9033238
references.citation: J Epidemiol Community Health. 2009 Nov;63(11):871-7
references.pmid: 19406742
references.citation: Demography. 2001 Feb;38(1):115-32
references.pmid: 11227840
references.citation: BMJ Open. 2012 Oct 31;2(6):
references.pmid: 23117564
references.citation: Matern Child Health J. 2013 Apr;17(3):493-500
references.pmid: 22527770
references.citation: BMC Pregnancy Childbirth. 2012 May 09;12:33
references.pmid: 22571689
references.citation: Health Policy Plan. 2009 May;24(3):175-88
references.pmid: 19282483
references.citation: BMC Public Health. 2007 Sep 27;7:268
references.pmid: 17900359
references.citation: Int J Epidemiol. 2010 Apr;39 Suppl 1:i102-9
references.pmid: 20348112
references.citation: Bull World Health Organ. 2011 Jun 1;89(6):402-411B
references.pmid: 21673856
references.citation: Lancet. 2005 Mar 12-18;365(9463):977-88
references.pmid: 15767001
references.citation: J Trop Pediatr. 2012 Jun;58(3):184-8
references.pmid: 21908545
references.citation: Lancet. 2001 May 19;357(9268):1565-70
references.pmid: 11377643
references.citation: PLoS One. 2012;7(5):e37037
references.pmid: 22623976
references.citation: Int J Epidemiol. 2006 Jun;35(3):706-18
references.pmid: 16556647
references.citation: PLoS One. 2011;6(11):e26856
references.pmid: 22073208
references.citation: Bull World Health Organ. 2001;79(7):608-14
references.pmid: 11477963
references.citation: Lancet. 2010 Nov 27;376(9755):1853-60
references.pmid: 21075444
references.citation: Health Policy Plan. 2006 Nov;21(6):459-68
references.pmid: 17030551
references.citation: Am J Clin Nutr. 2003 Oct;78(4):773-81
references.pmid: 14522736
references.citation: BMJ. 2008 Nov 07;337:a2001
references.pmid: 18996930