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Impact of antenatal care visits on childhood immunization: a propensity score-matched analysis using nationally
Yuvaraj Krishnamoorthy1, Tanveer Rehman2
1Department of Community Medicine, ESIC Medical College & PGIMSR, K.K. Nagar, Chennai, Tamil Nadu, India.
Insights
Antenatal care (ANC) visits significantly boost childhood immunization rates in India. Improving ANC coverage is crucial for enhancing child health outcomes and ensuring widespread immunization.
Area of Science:
- Public Health
- Epidemiology
- Maternal and Child Health
Background:
- Observational studies suggest a link between antenatal care (ANC) and childhood immunization.
- Selection bias in observational data complicates accurate impact assessment of ANC on immunization.
- Propensity score-matched analysis (PSM) was employed to mitigate bias and evaluate this relationship.
Purpose of the Study:
- To determine the causal impact of antenatal care (ANC) visits on childhood immunization coverage.
- To quantify the effect of ANC on immunization using a robust statistical methodology.
- To provide evidence-based recommendations for public health policy in India.
Main Methods:
- Utilized data from the National Family Health Survey-4 (NFHS-4), a nationally representative survey.
- Employed propensity score-matched (PSM) analysis with a logit model in STATA.
- Calculated average treatment effect on the population (ATE), treated (ATT), and untreated (ATU) for comprehensive analysis.
Main Results:
- Propensity score matching revealed a 24% increase in immunization coverage due to ANC visits (ATT).
- For women not attending ANC, a 25% increase in immunization coverage was estimated if they had attended four or more visits (ATU).
- The overall average treatment effect (ATE) for immunization coverage was estimated at 0.25, with good matching quality.
Conclusions:
- Antenatal care (ANC) visits are a significant determinant of improved childhood immunization coverage in India.
- Findings underscore the need for policymakers to prioritize and enhance ANC coverage to bolster immunization programs.
- Strengthening ANC services can lead to substantial improvements in public health outcomes for children.
Background:
Evidence has suggested a relationship between antenatal care (ANC) visits and childhood immunization coverage. However, evaluating its impact using observational data suffers from the problem of selection bias. Hence, we adopted propensity score-matched (PSM) analysis for studying the impact of ANC visits on childhood immunization.
Methods:
Data regarding ANC visits and childhood immunization were collected from a nationally representative survey, National Family Health Survey-4 (NFHS-4). We performed PSM analysis with logit model using the psmatch2 command package in STATA to find the average treatment effect on the population (ATE), treated (ATT), and untreated (ATU).
Results:
In total, 5,430 participants were included in the analysis. Radius matching with caliper width of 0.01 was used to match the groups. The ATT values in the intervention and control groups were 0.71 and 0.47, respectively, indicating that the immunization coverage was increased by 24% because of ANC visits. The ATU values in the intervention and control groups were 0.40 and 0.65, respectively. This indicates that for the women who did not make the ANC visits, the chance of getting their children immunized would have increased by 25% if they had made four or more visits. The final ATE estimate was 0.25 among the study participants. Quality of matching was good with no significant difference in characteristics between the two groups.
Conclusion:
Findings from our study imply that policymakers in India should focus on further improving the ANC coverage as it has a significant impact on improving childhood immunization coverage.
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