Work Description

Date: 23 December, 2024

Dataset Title: Malawi Group Antenatal Care Effectiveness Dataset

Data Creators: C.L. Patil

Dataset Contact: Crystal Patil [email protected]

Funding: This study was funded via Grant #R01NR018115, awarded to the University of Illinois Chicago from the National Institutes of Health, National Institute for Nursing Research
(NINR). The funder had no role in study design, data collection and analysis, decision to publish, or preparation of manuscripts.

Key Points:
- This dataset relates to the first aim of the study comparing outcomes for pregnant women randomly assigned to Group ANC or Individual ANC at seven clinics in Blantyre District, Malawi.

Research Overview:
We conducted a hybrid effectiveness-implementation trial with two aims. Details summarizing the study's conceptual basis, methods, and design are in a published protocol paper. This dataset was used to produce the results of the effectiveness aim with data collected between 5 July 2019 and 10 August 2023, comparing outcomes
for pregnant women randomly assigned to Group ANC or Individual ANC at seven clinics in Blantyre District, Malawi. The proposed sample size ensured a statistical power of > 99% for detecting effects on our clinical outcomes.

Methodology:
The data is a Microsoft Excel workbook (.xlsx) as formatted output form from the Statistical Analysis System (SAS) version 9.4.

Date Coverage: 5 July 2019 and 10 August 2023

Instrument and/or Software specifications: NA

Files contained here:
The EXCEL spreadsheet file `Malawi Group Antenatal Care Effectiveness Dataset` includes all variables used to assess effectiveness The variables included are described below:

The first part includes definitions of the individual-level and clinic-level covariates.

Individual-level covariates:

- Correct_ID: Participants' ID

- Assignment: The intervention indicator variable with Group ANC (intervention) and Individual ANC (control).

- Age: The participant's age was at the baseline visit.

- Age_Category: A 3-category ordinal variable: (1) `15-19` years (adolescents); (2) `20-29` years (young mothers); and (3) `30-35+` years (older mothers). Age `15-19` years is the reference category.

- Parity: A 2-category indicator is used: (1) `Primiparity` indicating a first pregnancy or (2) `Multiparity` indicating one or more previous pregnancies. `Primiparity` is the reference category.

- In a Relationship: Self-defined relationship status: (1) `Not in a relationship` (includes Separated or divorced, Single, and Widowed) or (2) `In a relationship` (married, living with a partner, or dating someone). `Not in a relationship` is the reference category.

- Education: A three-category ordinal variable: (1) `< Primary` (less than a primary education); (2) `Primary` (completed primary education); and (3) `SecondaryComplete` (more than a primary education). `< Primary` is the reference category.

- Food Insecurity: Participants were asked whether their household had ever run out of food or money to buy food in the last 12 months. For this dichotomous variable, `No never` (no food insecurity) is the reference category.

- Ownership Index: Participants were asked yes/no questions about having "electricity or a generator," "owning farm animals," and "agricultural land." The total number of yes responses produced the index as an ordinal variable (0-3), with 0 serving as the reference category.

- Income Quartile: Participants were asked to approximate the weekly income generated by the household. These values were converted to USD equivalents based on the year the survey was completed. Quartiles were produced and are treated as an ordinal variable: (1) `Q1` (Quartile 1, $0-$0.98); (2) `Q2` (Quartile 2, $0.98-$2.88); (3) `Q3` (Quartile 3, $2.88-$5.77); and (4) `Q4` (Quartile 4, >=$5.77). `Q1` is the reference category.

Clinic-level covariates:

- clinic_ID: ID of 7 clinics selected in the Blantyre district.

- Client-to-midwife ratio: Average number of new ACN clients per month divided by the number of midwives providing ANC. A higher ratio indicates a higher workload per midwife. Range, 7.4-29.0.

- Community catchment area: A 3-category ordinal indicator of the community clinics served: (1) `Rural` (n=2) have low population density and mainly agricultural economic activities; (2) `Peri-urban` (n=2) are near urban centers with a mix of rural and urban characteristics; and (3) `Urban` (n=3) are densely populated, with a more diverse economy. `Rural` is the reference category.

The second part includes outcome measures aligned with the theory of change model.

Supportive relationships, empowered partners in learning and care, meaningful services and information:

- Peer connectedness: An index indicating the number of yes responses for 14 items about feelings and exchanges from relationships with other pregnant women at ANC (e.g., acceptance, belonging, and advice); range 0-14.

- Pregnancy-related empowerment: The 16-item Likert-type scale [Klima CS et al., 2015] with 1 (strongly disagree) to 4 (strongly agree) capturing a sense of control over pregnancy health and healthcare across four domains: provider connectedness, skillful decision-making, peer connectedness, and gaining voice; range 16-64.

- ANC services: A checklist indicating the number of recalled ANC services: weight, gestational age, fetal heart tones, blood pressure, fetal position at every visit, and receiving prophylaxis for malaria and worms; range 0-9.

- ANC health promotion topics: A checklist indicating discussing 13 topics: healthy eating, danger signs, complications, malaria prevention, place of delivery, facility-based delivery, breastfeeding, early initiation of breastfeeding, birth spacing, family planning, safer sex, birth preparedness, and exclusive breastfeeding); range 0-13.

- Repeat HIV test at ANC: If seronegative at intake, have at least one additional HIV test at ANC (yes/no). `No` is the reference category.

ANC Experience:

- Wait time for ANC services: Typical wait time of more than one hour for ANC services (yes/no). `Yes, more than one hour` is the reference category.

- Satisfaction with ANC: A 10-item scale rating satisfaction with the overall quality of the care, procedures, and providers’ level of respect and listening skills; 5-point Likert scale; range 10-50.

- ANC contacts:
- Number of contacts: Total number of ANC contacts, 1-8+, mean and standard deviation.
- ANC4+: Whether 4 or more ANC contacts were reported during this pregnancy (yes/no). No is the reference category.
- ANC8+: Whether 8 or more ANC contacts were reported during this pregnancy (yes/no). No is the reference category.

- Prefer Group ANC in a future pregnancy: In late pregnancy, participants were asked if they would prefer Individual or Group ANC if they got pregnant in the future. `Individual ANC` is the reference category.

Knowledge:

- Healthy pregnancy knowledge: 25 yes/no items based on content supporting a healthy pregnancy, birth, and infant, such as dander signs, healthy eating, newborn care, birth spacing, family planning, and infant feeding; range 0-25.

- Healthy Pregnancy Knowledge (baseline) - Baseline score

- Healthy Pregnancy Knowledge - Score at time T2 [CHK]

- UNAIDS knowledge:
- score: UNAIDS comprehensive HIV prevention knowledge [Joint United Nations Programme on HIV/AIDS, 2003] is the number of correct responses to five questions: if a healthy-looking person can have HIV, whether condom use and having only one uninfected partner reduce the likelihood of getting HIV transmission and two of the most common local misconceptions about HIV transmission (casual contact and mosquito bites).

- All correct: A `yes`/`no` indicator that all five UNAIDS questions were answered correctly. `No, not all correct` is the reference category.

- UNAIDS knowledge, all correct (baseline) - Baseline score

- UNAIDS knowledge, score - Score at time T2 [CHK]

Health-promoting behavior:

- Dietary diversity: 6 yes/no items indicated food categories eaten in the previous 24 hours: 1) ≥ 3 fruits or vegetables; 2) chicken, fish, eggs, insects or other meat; 3) groundnuts or groundnut powder, dried beans or peas, or soya; 4) leafy green vegetables; 5) yellow or orange fruits or vegetables; and 6) milk (fresh or fermented) or yogurt, range 0-6.

- Dietary diversity (baseline) - Baseline score

- Dietary diversity - Score at time T2 [CHK]

- Birth preparedness: A checklist of 5 recommended behaviors including if the woman talked to the midwife about where she planned to deliver, if she obtained supplies, arranged transportation, set aside money, and identified a blood donor, range 0-5.

- Birth preparedness (baseline) - Baseline score

- Birth preparedness - Score at T2 [CHK]

- Exclusive breastfeeding: Exclusive breastfeeding for six months (`yes`/`no`). `No` is the reference category.

- Consistent condom use: Participants reported whether a condom was used with every sexual encounter in the last two months (`yes`/`no`). `No` is the reference category

- Consistent condom use (baseline) - Baseline score

- Consistent condom use - Score at T2 [CHK]

Communication and Care beyond ANC:

- Partner communication: 6-item yes/no index capturing whether the couple communicated about specific topics: 1) healthy diets, 2) exclusive breastfeeding, 3) difficult subjects, 4) family planning, 5) HIV testing, or 6) use of condoms, range 0-6.

- Partner communication (baseline) - Baseline score

- Partner communication - Score at T2 [CHK]

- Partner HIV test disclosure: Whether a partner who was not HIV positive at the intake visit took an HIV test and shared results during this pregnancy (`yes`/`no`). `No` is the reference category

- Partner HIV test disclosure (baseline) - Baseline score

- Partner HIV test disclosure - Score at T2 [CHK]

- Facility-based delivery: Woman gave birth in a health facility (`yes`/`no`). `No` is the reference category.

- Postnatal care attendance: An indicator of attending ≥1 postnatal visit after discharge (`yes`/`no`). `No` is the reference category.

- Family planning: Reported use of family planning at late postpartum, approximately 6 months after delivery (`yes`/`no`). `No` is the reference category.

Clinical:

- Birth weight: Whether a newborn weighed <2,500 grams (5.5 pounds) at birth (`yes`/`no`). `No` is the reference category.

- Mental health: Self-Reporting Questionnaire has 20 yes/no items that screen for symptoms of anxiety, depression, psychosomatic symptoms, reduced vital energy, and depressive thoughts [Dow A. et al., 2014; World Health Organization, 1994], range 0-20 with a higher score indicating higher mental distress.

- Mental Health (baseline) - Baseline score

- Mental Health - Score at T2 [CHK]

- Deathcode: Still or live birth status

- Cesarean Section: C-section delivery status [CHK]

-Hypertension in pregnancy: Hypertension during current pregnancy

-Anemia - Baseline status for anemia [CHK]

Related publication(s):
Klima CS, Vonderheid SC, Norr KF, Park CG. Development of the Pregnancy-related Empowerment Scale. Nurs Health. 2015;3:120–7.
Joint United Nations Programme on HIV/AIDS. Monitoring the declaration of commitment on HIV/AIDS: guidelines on construction of core indicators. 2003.
Dow A, Dube Q, Pence BW, Van Rie A. Postpartum Depression and HIV Infection among Women in Malawi. J Acquir Immune Defic Syndr 1999. 2014;65:359–65.
World Health Organization. A User’s Guide to the Self Reporting Questionnaire (SRQ). Geneva; 1994.

Use and Access:
[PLEASE FILL]

To Cite Data:
[PLEASE FILL]