title: Antenatal care as a means of increasing birth in the health facility and reducing maternal mortality: a systematic review.
abstract: BACKGROUND
  Although there is a general agreement on the importance of antenatal care to improve the maternal and perinatal health, little is known about its importance to improve health facility delivery in developing countries. The objective of this study was to assess the association of antenatal care with birth in health facility.
  
  
  METHODS
  A systematic review with meta-analysis of Mantel-Haenszel odds ratios was conducted by including seventeen small scale studies that compared antenatal care and health facility delivery between 2003 and 2013. Additionally, national survey data of African countries which included antenatal care, health facility delivery and maternal mortality in their report were included. Data were accessed via a computer based search from MEDLINE, African Journals Online, HINARI and Google Scholar databases.
  
  
  RESULTS
  The regression analysis of antenatal care with health facility delivery revealed a positive correlation. The pooled analysis also demonstrated that woman attending antenatal care had more than 7 times increased chance of delivering in a health facility. The comparative descriptive analysis, however, demonstrated a big gap between the proportion of antenatal care and health facility delivery by the same individuals (27%-95% vs 4%-45%). Antenatal care and health facility delivery had negative correlation with maternal mortality.
  
  
  CONCLUSIONS
  The present regression and meta-analysis has identified the relative advantage of having antenatal care to give birth in health facilities. However, the majority of women who had antenatal care did not show up to a health facility for delivery. Therefore, future research needs to give emphasis to identifying barriers to health facility delivery despite having antenatal care follow up.
authors.affiliation: Hawassa University, College of Medicine and Health Sciences, Department of Gynecology-Obstetrics.
authors.forename: Yifru
authors.initials: Y
authors.lastname: Berhan
authors.affiliation: Hawassa University, College of Medicine and Health Sciences, Department of Pharmacology.
authors.forename: Asres
authors.initials: A
authors.lastname: Berhan
mesh_terms: D000349:Africa / Q000453:epidemiology; D003696:Delivery Rooms; D036861:Delivery, Obstetric; D003906:Developing Countries; D005260:Female; D006268:Health Facilities; D006801:Humans; D063130:Maternal Death / Q000517:prevention & control*; D008427:Maternal Health Services; D008428:Maternal Mortality; D011247:Pregnancy; D011295:Prenatal Care
keywords: antenatal care; community based studies; developing countries; health facility delivery; meta-analysis