Table 1
Indicators used for matching the controls with the case facilities.
| Offers ANC June 2012 | Gives IFA June 2012 | Catchment Areas 2014 | Average ANC attendees/month June 2012 | Has IPT for prevention 2012 | Anti-malarial treatment 2012 | |
|---|---|---|---|---|---|---|
| Abuja Cases | ||||||
| Pyakasa | Yes | Yes | 12,419 | 20 | Yes | Yes |
| Gbagalpe | Yes | Yes | 19,967 | 100 | No | No |
| Ketti | Yes | Yes | 36,824 | 20 | No | Yes |
| Kobi | Yes | Yes | 16,290 | 6 | No | No |
| Idu Karimi | Yes | Yes | 6,972 | 11 | No | No |
| Total | 92,472 | 157 | ||||
| Abuja Controls | ||||||
| Bassan’jiwa | Yes | Yes | 81,000 | 6 | Yes | Yes |
| Dutse Garki | Yes | Yes | 1,488 | 30 | Yes | Yes |
| Jahi PHC | Yes | Yes | 1,725 | 12 | Yes | Yes |
| Kabusa PHC | Yes | Yes | 3,050 | 19 | Yes | Yes |
| DamangorovPHC | Yes | Yes | 17,525 | 56 | Yes | Yes |
| Total | 104,788 | 123 | ||||
| Nassarawa Cases | ||||||
| Keffi Wambai | Yes | Yes | 4,700 | 5 | No | Yes |
| Lafia East | Yes | Yes | 17,350 | 180 | No | Yes |
| Mana PHC | Yes | Yes | 14,360 | 80 | Yes | Yes |
| Sabon Gari | Yes | Yes | 8,089 | 24 | Yes | Yes |
| Nassarawa Egon | Yes | Yes | 34,065 | 60 | Yes | Yes |
| Total | 78,564 | 349 | ||||
| Nassarawa Controls | ||||||
| Adogi | Yes | Yes | 26,175 | 127 | No | Yes |
| Angwon Toni | Yes | Yes | 6,502 | No | Yes | |
| Akuba Lafia | Yes | Yes | 10,972 | 85 | Yes | Yes |
| Agyaragu | Yes | Yes | 6,502 | 81 | Yes | Yes |
| Tudan Gwandara | Yes | Yes | 13,500 | 82 | Yes | Yes |
| Total | 63,651 | 375 |
Table 2
Data extracted from NHMIS database.
| Variable Name | Extraction Dates |
|---|---|
| ANC proteinuria test done | 2014, monthly |
| ANC proteinuria test positive | 2014, monthly |
| ANC syphilis case treated | 2014, monthly |
| ANC syphilis test done | 2014, monthly |
| ANC syphilis test positive | 2014, monthly |
| Antenatal attendance – Total | 2013–2015, monthly |
| Antenatal first visit – Total | 2013–2015, monthly |
| Deliveries – Complications | 2013–2015, monthly |
| Deliveries – Preterm | 2013–2015, monthly |
| Deliveries – Caesarian Section | 2013–2015, monthly |
| Deliveries – SVD (Spontaneous Vaginal Delivery) | 2013–2015, monthly |
| Deliveries taken by a skilled birth attendant | 2013–2015, monthly |
| Deliveries – Total | 2013–2015, monthly |
| Delivery Assisted | 2013–2015, monthly |
| Facility attendance – Total | 2013–2015, monthly |
| OPD attendance – Total | 2014, monthly |
| Persons with clinically diagnosed malaria | 2014, monthly |
| Pregnant women who received Haematinics’ IFAs-Iron and Folic Acid supplements | 2014, monthly |
| Pregnant women who received malaria IPT1 | 2014, monthly |
| Pregnant women who received malaria IPT2 | 2014, monthly |
| TT1 for nonpregnant women | 2014, monthly |
| TT1 for pregnant women | 2014, monthly |
| TT2 for nonpregnant women | 2014, monthly |
| TT2 for pregnant women | 2014, monthly |
| Women referred out for pregnancy related complications | 2013–2015, monthly |
Table 3
Data Description for Antenatal Care and Facility Delivery Coverage Indicators.
| Antenatal Care Indicators | |
|---|---|
| Tetanus Toxoid Coverage (%) | Number Tetanus Toxoid 1 given/Number of ANC 1 patients |
| Malaria IPT Coverage (%) | Number Malaria IPT 1 given/Number of ANC 1 patients |
| Iron/Folic Acid (IFA) Coverage (%) | Number IFA given to ANC/All ANC |
| Hypertension Screening3 Coverage (%) | Number ANC proteinuria test done/All ANC |
| Syphilis Detection4 Coverage (%) | Number ANC syphilis test done/All ANC |
| Facility Delivery Indicators | |
| Public Facility Delivery (%) | Number of spontaneous vaginal deliveries recorded in the health facility/All ANC |
| Private Facility Delivery (%) | Percent of private facility deliveries* |
| General Health Facility (%) | Number of Caesarean sections, complications, preterm deliveries and referrals/All ANC |
| Unassisted Deliveries (%) | Percent of Unassisted facility deliveries** |
[i] Source: DHIS2 Health Management Information System; *Calculated using NHMIS data and DHS ratio of private to public deliveries, **Calculated using NHMIS data and DHS ratio of unassisted to private deliveries.
Table 4
Reported and Calculated Catchment Areas for the 20 Facilities.
| Catchment Area Cases and Controls | |||
|---|---|---|---|
| Cases | 2014 | Controls | 2014 |
| Pyakasa | 12,419 | Bassan’jiwa | 81,000 |
| Gbagalpe | 19,967 | Dutse-Garki | 1,488 |
| Ketti | 36,824 | Jahi | 1,725 |
| Kobi | 16,290 | Kabusa | 3,050 |
| Idu Karimi | 6,972 | Gidanmangoro | 17,525 |
| Total Abuja | 92,472 | Total Abuja | 104,788 |
| Keffi Wambai | 4,700 | Agyaragu | 6,502 |
| Lafia East | 17,350 | Adogi | 26,175 |
| Mana PHC | 14,360 | Akuba Lafia | 10,972 |
| Sabon Gari | 8,089 | Angwon Toni | 6,502 |
| Nassarawa Egon | 34,065 | Tudan Gwandara | 13,500 |
| Total Nassarawa | 78,564 | Total Nassarawa | 63,651 |
| Total | 171,036 | Total | 168,439 |
Table 5
Difference in Coverage Indicators between Cases and Controls, Abuja and Nassarawa.
| Coverage Indicators | Abuja | Nassarawa | ||
|---|---|---|---|---|
| Case | Control | Case | Control | |
| ANC | ||||
| Tetanus Toxoid Coverage (%) | 100 | 73 | 72 | 39 |
| Malaria IPT Coverage (%) | 100 | 71 | 77 | 35 |
| Iron/Folic Acid (IFA) Coverage (%) | 100 | 85 | 100 | 100 |
| Syphilis Detection Coverage (%) | 31 | 19 | 54 | 0 |
| Hypertension Screening (%) | 50 | 26 | 27 | 48 |
| Deliveries | ||||
| Public Facilities Delivery (%) (Emoc) | 8.95 | 12.73 | 10.45 | 13.54 |
| Private Facilities Delivery (%) (Bemoc) | 6.38 | 5.93 | 5.23 | 6.06 |
| General Hospital Delivery (%) (Cemoc) | 5.93 | 1.10 | 1.76 | 0.60 |
| Unassisted Deliveries (%) | 76.37 | 78.04 | 80.61 | 77.55 |
Table 6
Maternal, Stillbirth and Neonatal Deaths Averted from ANC Coverage and Facility Deliveries in Cases versus Controls in Abuja and Nassarawa.
| Antenatal Care Interventions | Facility Deliveries: Actual level of unassisted deliveries | Additional Facility Deliveries: Unassisted deliveries 50% | |
|---|---|---|---|
| Tetanus Toxoid Coverage | 1.116 | ||
| Malaria IPT Coverage | 1.311 | ||
| Hypertension Screening Coverage | 0.081 | 0.054 | 8.052 |
| Syphilis Detection Coverage | 2.146 | ||
| Iron/Folic Acid (IFA) Coverage | 0.006 | ||
| Total Lives Saved | 4.661 | 0.054 | 8.052 |
| Disability Adjusted Life Years (DALYs) | |||
| Total Lives Saved (Antenatal Care and Facility Delivery) | 4.71 | 12.71 | |
| Total DALYs | 109 | 295 | |
Table 7
Cost for Initiation and Implementation of antenatal care assisted with mobile hand-held device (US$) (Standard Deviation in parentheses).
| Cost Categories | Cases | Controls |
|---|---|---|
| Personnel | 84,388.19 (5,713.83) | 95,894.86 (5,964.96) |
| Recurrent | 44,294.37 (5,321.51) | 42,957.27 (2,534.05) |
| Capital | 52.48 (6.25) | 956.17 (74.70) |
| Societal | 25,049.95 (3,070.28) | 20,080.08 (1,404.59) |
| Total Costs (US$) | 153,784.99 (13,555.11) | 159,888.38 (7,050.17) |
| Average Cost per Facility | 15,378.49 (1,355.51) | 15,988.84 (705.02) |
Table 8
Facility Delivery Costs Associated with Increased Antenatal Care (US$) (Standard Deviation in Parentheses).
| Cost Categories | Facility Deliveries: Actual level of unassisted deliveries | Additional Facility Deliveries: Unassisted deliveries 50% | ||
|---|---|---|---|---|
| Cases | Controls | Cases | Controls | |
| Facility Deliveries | $38,378 (4,365.83) | $34,916 (3,365.17) | $98,240 (10,827.67) | $34,916 (3,365.17) |
Table 9
Cost Effectiveness Ratios, Cases versus Controls, 2014.
| Baseline lives saved | Lives saved with increased unassisted deliveries to 50% | ||||
|---|---|---|---|---|---|
| Cases | Controls | Cases | Controls | ||
| Costs | |||||
| ANC | $153,785 | $159,888 | $153,784 | $159,888 | |
| mHealth | $67,407 | $0 | $67,407 | $0 | |
| Total | $221,192 | $159,888 | $221,192 | $159,888 | |
| Change (ANC) | $61,304 | $61,304 | |||
| Delivery | $38,378 | $34,916 | $98,240 | $34,916 | |
| Change (Delivery) | $3,462 | $63,324 | |||
| Change (ANC + Delivery) | $64,766 | $124,628 | |||
| Effectiveness (ANC only) | |||||
| Lives Saved | 4.66 | 4.66 | |||
| DALY Averted | 108 | 108 | |||
| Effectiveness (ANC and facility delivery) | |||||
| Lives Saved (Facility Delivery) | 0.054 | 8.05 | |||
| Lives Saved (ANC + Delivery) | 4.71 | 12.71 | |||
| DALY (Facility Delivery) | 1 | 186 | |||
| DALY (ANC + Delivery) | 109 | 295 | |||
| Cost Effectiveness (ANC only) | |||||
| Per life saved | $13,155 | $13,155 | |||
| Per DALY averted | $568 | $568 | |||
| Cost Effectiveness (ANC + Facility Delivery) | |||||
| Per life saved | $13,739 | $9,806 | |||
| Per DALY averted | $594 | $424 | |||