title: Antenatal care strengthening for improved health behaviours in Jimma, Ethiopia, 2009-2011: An effectiveness study.
abstract: BACKGROUND
  health systems in low-income settings are not sufficiently reaching the poor, and global disparities in reproductive health persist. The frequency and quality of health education during antenatal care is often low. Further studies are needed on how to improve the performance of health systems in low income settings to improve maternal and child health.
  
  
  OBJECTIVE
  to assess the effectiveness of a participatory antenatal care intervention on health behaviours and to illuminate how the different socioeconomic groups responded to the intervention in Jimma, Ethiopia. SETTING, INTERVENTION AND MEASUREMENTS: an intervention was designed participatorily and comprised trainings, supervisions, equipment, health education material, and adaption of guidelines. It was implemented at public facilities. Household surveys, before (2008) and after (2010) intervention, were conducted amongst all women who had given birth within the previous 12 months. The effect of the intervention was assessed by comparing the change in health behaviours (number of antenatal visits, health facility delivery, breast feeding, preventive infant health check, and infant immunisation) from before to after the intervention period at intervention sites, relative to control sites, using logistic mixed effect regression.
  
  
  RESULTS
  on the basis of 1357 women included before and 2262 after the intervention, there were positive effects of the intervention on breast feeding practices (OR 3.0, 95% CI: 1.4; 3.6) and preventive infant health check (OR 2.4, 95% CI: 1.5; 3.5). There was no effect on infant immunisation coverage and negative effect on number of antenatal visits. The effect on various outcomes was modified by maternal education, and results indicate increased health facility delivery (OR 2.4, 95% CI: 0.8; 6.9) and breast feeding practices (OR 18.2, 95% CI: 5.2;63.6) among women with no education.
  
  
  CONCLUSIONS
  the facility based intervention improved some, but not all health behaviours. The improvements indicated amongst the most disadvantaged antenatal care attendants in breast feeding and health facility delivery are encouraging and underline the need to scale up priority of antenatal care in the effort to reduce maternal and child health inequity.
authors.affiliation: Department of Nutrition, Exercise and Sport, Faculty of Science, University of Copenhagen, Rolighedsvej 25, 1958 Frb. C, Denmark; Department of Public Health, Faculty of Health and Medical Sciences, University of Copenhagen, Oester Farimagsgade 5, Post box 2099, 1014 Copenhagen K, Denmark. Electronic address: sfv@sund.ku.dk.
authors.forename: Sarah Fredsted
authors.initials: SF
authors.lastname: Villadsen
authors.affiliation: Department of Obstetrics and Gynaecology, Jimma University Specialized Hospital, Post Box 480, Jimma, Ethiopia.
authors.forename: Dereje
authors.initials: D
authors.lastname: Negussie
authors.affiliation: Department of Population and Family Health, Jimma University, Post Box 480, Jimma, Ethiopia.
authors.forename: Abebe
authors.initials: A
authors.lastname: GebreMariam
authors.affiliation: JUCAN Research Collaboration, Jimma University, Post Box 480, Jimma, Ethiopia.
authors.forename: Abebech
authors.initials: A
authors.lastname: Tilahun
authors.affiliation: Department of Paediatrics, Jimma University Specialized Hospital, Jimma, Ethiopia.
authors.forename: Tsinuel
authors.initials: T
authors.lastname: Girma
authors.affiliation: Department of Nutrition, Exercise and Sport, Faculty of Science, University of Copenhagen, Rolighedsvej 25, 1958 Frb. C, Denmark.
authors.forename: Henrik
authors.initials: H
authors.lastname: Friis
authors.affiliation: Department of Obstetrics and Gynaecology, Odense University Hospital, Soendre Boulevard 29, Odense, Denmark.
authors.forename: Vibeke
authors.initials: V
authors.lastname: Rasch
mesh_terms: D000328:Adult; D001942:Breast Feeding; D003906:Developing Countries; D005002:Ethiopia; D005260:Female; D015438:Health Behavior; D006293:Health Promotion / Q000379:methods*; D006297:Health Services Accessibility / Q000592:standards; D006801:Humans; D007223:Infant; D000068104:Infant Health; D017063:Outcome Assessment, Health Care / Q000592:standards*; D011181:Postnatal Care / Q000592:standards; D011247:Pregnancy; D011295:Prenatal Care / Q000592:standards; D011314:Preventive Health Services / Q000379:methods / Q000592:standards; D011795:Surveys and Questionnaires; D013663:Teaching / Q000592:standards
keywords: Antenatal care; Breast feeding; Delivery; Health care systems; Intervention studies; Reproductive health