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Effect of Antenatal Care Attendance on Low Birth Weight among Newborns in Nigeria

Abstract

Low birth weight remains an important public health and maternal-child health concern in Nigeria and is associated with increased risks of neonatal morbidity, mortality, impaired growth, developmental problems, and other adverse health outcomes. Low birth weight may result from several maternal, fetal, nutritional, socioeconomic, and healthcare-related factors, including maternal infections, anaemia, malaria during pregnancy, inadequate maternal nutrition, hypertension, preterm birth, and limited access to appropriate antenatal care. Antenatal care provides an important platform for identifying and managing maternal and pregnancy-related conditions, promoting healthy behaviours, providing preventive interventions, monitoring fetal growth, and preparing women for safe delivery. However, late initiation of antenatal care, inadequate attendance, missed appointments, limited access to quality services, and disparities in healthcare availability may reduce its potential benefits. Against this background, this study investigates the effect of antenatal care attendance on low birth weight among newborns in Nigeria. The study will be anchored on the Health Belief Model, Social Ecological Model, and Health Systems Framework. The Health Belief Model explains how pregnant women's perceptions of pregnancy-related risks, perceived benefits of antenatal care, perceived barriers, and cues to action may influence attendance and utilization of antenatal services. The Social Ecological Model emphasizes the influence of individual, household, community, socioeconomic, healthcare, and policy factors on antenatal care utilization and birth outcomes. The Health Systems Framework emphasizes service delivery, health workforce, health information, medicines and technologies, financing, governance, and accessibility as essential components of effective maternal healthcare. Collectively, these theoretical perspectives provide a suitable framework for explaining how antenatal care attendance may influence low birth weight among newborns in Nigeria. The study will adopt a quantitative analytical cohort or retrospective cohort research design. The study population will comprise pregnant women who received antenatal care in selected healthcare facilities in Nigeria and their newborns. A multistage sampling technique will be used to select states, local government areas, healthcare facilities, antenatal clinics, pregnant women, and eligible mother-newborn pairs. Antenatal care attendance will be assessed using indicators such as timing of first antenatal visit, total number of antenatal visits, continuity of attendance, completion of recommended contacts, attendance during different stages of pregnancy, receipt of essential antenatal interventions, and documented management of pregnancy-related conditions. Low birth weight will be assessed using newborn birth weight measured at delivery, with low birth weight defined as a birth weight below 2,500 grams. Additional birth outcomes, including preterm birth, may be assessed to provide further context. Data will be collected using structured questionnaires, antenatal care records, maternal health records, delivery registers, maternity records, newborn records, and birth-weight documentation. Descriptive statistics will be used to summarize maternal and newborn characteristics, antenatal care attendance patterns, and birth-weight outcomes. Inferential statistical techniques, including chi-square tests, t-tests, correlation analysis, and logistic or multiple regression analysis where appropriate, will be used to determine the effect of antenatal care attendance on low birth weight. Where a cohort design is adopted, the prevalence of low birth weight among women with adequate antenatal care attendance may be compared with that among women with inadequate or late attendance, while relevant maternal, socioeconomic, and pregnancy-related factors are appropriately controlled. Diagnostic tests will also be conducted to assess the reliability, validity, and robustness of the findings. The study is expected to find that adequate and timely antenatal care attendance has a significant protective effect against low birth weight among newborns in Nigeria. Newborns of women who initiate antenatal care early and maintain regular attendance are expected to have a lower likelihood of low birth weight compared with newborns of women who initiate care late or attend antenatal services inadequately. Regular antenatal care may facilitate early identification and management of maternal anaemia, malaria, hypertension, infections, nutritional deficiencies, and other pregnancy complications that may contribute to poor fetal growth or preterm birth. Antenatal care may also provide opportunities for nutritional counselling, preventive interventions, health education, and monitoring of maternal and fetal wellbeing. However, socioeconomic disadvantage, geographical barriers, poor quality of care, limited healthcare resources, maternal illness, inadequate nutrition, and other factors may continue to influence birth weight even among women attending antenatal care. The study therefore expects timely, regular, accessible, and quality antenatal care to contribute significantly to reducing the occurrence of low birth weight among newborns in Nigeria. The study is expected to contribute to the literature on antenatal care attendance, low birth weight, maternal healthcare utilization, newborn health, maternal and child health, pregnancy outcomes, and public health in Nigeria. The findings will provide useful information to the Federal Ministry of Health and Social Welfare, National Primary Health Care Development Agency, state ministries of health, healthcare facilities, maternal and child health programmes, obstetricians, midwives, community health workers, development partners, and policymakers regarding strategies for improving antenatal care utilization and birth outcomes. The study will also provide evidence-based recommendations for promoting early antenatal care initiation, improving continuity and quality of antenatal services, reducing barriers to maternal healthcare utilization, strengthening screening and management of pregnancy complications, improving maternal nutrition, enhancing community awareness of antenatal care, and integrating antenatal care interventions with broader maternal and newborn health programmes across Nigeria.

Keywords: Antenatal care attendance, low birth weight, newborns, maternal healthcare utilization, pregnancy outcomes, maternal health, newborn health, antenatal care, birth weight, Nigeria, public health.