title: Provider adherence to first antenatal care guidelines and risk of pregnancy complications in public sector facilities: a Ghanaian cohort study.
abstract: Guideline utilization aims at improvement in quality of care and better health outcomes. The objective of the current study was to determine the effect of provider complete adherence to the first antenatal care guidelines on the risk of maternal and neonatal complications in a low resource setting.
  
  
  
  Women delivering in 11 health facilities in the Greater Accra region of Ghana were recruited into a cohort study. Their first antenatal visit records were reviewed to assess providers' adherence to the guidelines, using a thirteen-point checklist. Information on their socio-demographic characteristics and previous pregnancy history was collected. Participants were followed up for 6 weeks post-partum to complete data collection on outcomes. The incidence of maternal and neonatal complications was estimated. The effects of complete adherence on risk of maternal and neonatal complications were estimated and expressed as relative risks (RRs) with their 95% confidence intervals (CI) adjusted for a potential clustering effect of health facilities.
  
  
  
  Overall, 926 women were followed up to 6 weeks post-partum. Mean age (SD) of participants was 28.2 (5.4) years. Complete adherence to guidelines pertained to the care of 48.5% of women. Incidence of preterm deliveries, low birth weight, stillbirths and neonatal mortality were 5.3, 6.1, 0.4 and 1.4% respectively. Complete adherence to the guidelines decreased risk of any neonatal complication [0.72 (0.65-0.93); p = 0.01] and delivery complication [0.66 (0.44-0.99), p = 0.04].
  
  
  
  Complete provider adherence to antenatal care guidelines at first antenatal visit influences delivery and neonatal outcomes. While there is the need to explore and understand explanatory mechanisms for these observations, programs that promote complete adherence to guidelines will improve the pregnancy outcomes.
authors.affiliation: Postdoctoral Unit, Noguchi Memorial Institute for Medical Research, University of Ghana, Legon, Accra, Ghana. menba19@yahoo.com.|Julius Global Health, Julius Center for Health Sciences and Primary Care, University Medical Centre Utrecht, Utrecht, The Netherlands. menba19@yahoo.com.|Department of Epidemiology and Disease Control, School of Public Health, University of Ghana, Legon, Ghana. menba19@yahoo.com.
authors.forename: Mary
authors.initials: M
authors.lastname: Amoakoh-Coleman
authors.affiliation: Julius Global Health, Julius Center for Health Sciences and Primary Care, University Medical Centre Utrecht, Utrecht, The Netherlands.|Division of Epidemiology & Biostatistics, School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.
authors.forename: Kerstin
authors.initials: K
authors.lastname: Klipstein-Grobusch
authors.affiliation: Department of Health Policy, Planning and Management, School of Public Health, University of Ghana, Legon, Ghana.|Research and Development Division, Ghana Health Service, Accra, Ghana.
authors.forename: Irene Akua
authors.initials: IA
authors.lastname: Agyepong
authors.affiliation: Julius Global Health, Julius Center for Health Sciences and Primary Care, University Medical Centre Utrecht, Utrecht, The Netherlands.
authors.forename: Gbenga A
authors.initials: GA
authors.lastname: Kayode
authors.affiliation: Julius Global Health, Julius Center for Health Sciences and Primary Care, University Medical Centre Utrecht, Utrecht, The Netherlands.
authors.forename: Diederick E
authors.initials: DE
authors.lastname: Grobbee
authors.affiliation: Research and Development Division, Ghana Health Service, Accra, Ghana.
authors.forename: Evelyn K
authors.initials: EK
authors.lastname: Ansah
mesh_terms: D000328:Adult; D000740:Anemia / Q000453:epidemiology; D005260:Female; D005869:Ghana / Q000453:epidemiology; D019983:Guideline Adherence / Q000706:statistics & numerical data*; D006268:Health Facilities / Q000706:statistics & numerical data*; D006801:Humans; D046110:Hypertension, Pregnancy-Induced / Q000453:epidemiology; D007223:Infant; D007226:Infant Mortality; D007230:Infant, Low Birth Weight; D007231:Infant, Newborn; D006473:Postpartum Hemorrhage / Q000453:epidemiology; D017410:Practice Guidelines as Topic; D011247:Pregnancy; D011248:Pregnancy Complications / Q000453:epidemiology*; D047928:Premature Birth / Q000453:epidemiology; D011295:Prenatal Care / Q000592:standards*; D011446:Prospective Studies; D017150:Public Sector; D012189:Retrospective Studies; D012307:Risk Factors; D050497:Stillbirth / Q000453:epidemiology; D055815:Young Adult
keywords: Adherence; Antenatal care; First antenatal visit; Maternal; Neonatal; Outcomes