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Journal Article

Aug 16, 2024

Antenatal Care (ANC) | Complications

Effect of group antenatal care versus individualized antenatal care on birth preparedness and complication readiness: a cluster randomized controlled study among pregnant women in Eastern Region of Ghana

Knowing that antenatal care is where most pregnant women learn about how to be best prepared for delivery, we sought to explore whether group antenatal care (G-ANC) would yield improved birth preparedness and recognition of danger signs when compared to routine, individual antenatal care(I-ANC).

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Authors

Vida A Kukula

Elizabeth Awini

Bidisha Ghosh

Veronica Apetorgbor

Ruth Zielinski

Georgina Amankwah

Winfred K Ofosu

Katherine James

John E O Williams

Jody R Lori

Cheryl A Moyer

Authors

Vida A Kukula, Elizabeth Awini, Bidisha Ghosh , Veronica Apetorgbor, Ruth Zielinski, Georgina Amankwah, Winfred K Ofosu, Katherine James, John E O Williams, Jody R Lori , Cheryl A Moyer

Related Topics
Antenatal Care (ANC)ComplicationsMaternalMidwifery
Countries

Ghana

Regions

Africa

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Background

As utilization of individual antenatal care (I-ANC) has increased throughout sub-Saharan Africa, questions have arisen about whether individual versus group-based care might yield better outcomes. We implemented a trial of group-based antenatal care (G-ANC) to determine its impact on birth preparedness and complication readiness (BPCR) among pregnant women in Ghana.

Methods

We conducted a cluster randomized controlled trial comparing G-ANC to routine antenatal care in 14 health facilities in the Eastern Region of Ghana. We recruited women in their first trimester to participate in eight two-hour interactive group sessions throughout their pregnancies. Meetings were facilitated by midwives trained in G-ANC methods, and clinical assessments were conducted in addition to group discussions and activities. Data were collected at five timepoints, and results are presented comparing baseline (T0) to 34 weeks’ gestation to 3 weeks post-delivery (T1) for danger sign recognition, an 11-point additive scale of BPCR, as well as individual items comprising the scale.

Results

1285 participants completed T0 and T1 assessments (N = 668 I-ANC, N = 617, G-ANC). At T1, G-ANC participants were able to identify significantly more pregnancy danger signs than I-ANC participants (mean increase from 1.8 to 3.4 in G-ANC vs. 1.7 to 2.2 in I-ANC, p < 0.0001). Overall BPCR scores were significantly greater in the G-ANC group than the I-ANC group. The elements of BPCR that showed the greatest increases included arranging for emergency transport (I-ANC increased from 1.5 to 11.5% vs. G-ANC increasing from 2 to 41% (p < 0.0001)) and saving money for transportation (19–32% in the I-ANC group vs. 19–73% in the G-ANC group (p < 0.0001)). Identifying someone to accompany the woman to the facility rose from 1 to 3% in the I-ANC group vs. 2–20% in the G-ANC group (p < 0.001).

Conclusions

G-ANC significantly increased BPCR among women in rural Eastern Region of Ghana when compared to routine antenatal care. Given the success of this intervention, future efforts that prioritize the implementation of G-ANC are warranted.

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