Study setting, design and participants

The study site is located in Matlab upazila under Chandpur district. The International Centre for Diarrhoeal Disease Research, Bangladesh (icddr, b) has been running a Health and Demographic Surveillance System (HDSS) over a population of about 220 000 in the area since 1966. In half of the HDSS area, icddr, b provides healthcare services to the women of childbearing ages and their children less than 5 years in age. This service area is divided into four administrative blocks. Each block serves a population of about 27 000 through a subcentre, staffed by midwives, that provides 24 hours delivery care. Clinical services in the subcentres are supported by an icddr, b Hospital, located in Matlab Municipality, that offers basic obstetric care and is staffed by medical doctors and nurses. In the study area, icddr, b provides all services including ANC free-of-cost. It also ensures the availability of healthcare providers, and all logistics and supplies to facilitate the uptake of recommended services to all clients.

In this paper, we first analysed the prospectively collected data from 2005 to 2009 to evaluate the association between the number of ANC visits and preterm birth occurrences. We then used a before-after study design within the cohort to assess the effect of ANC coverage on preterm birth occurrences between the periods before (2005 to 2006) and after (2008 to 2009) implementation of the MNCH project. In total, 12 980 women who delivered live birth babies during the study period were included in the analysis.

The study participants in the MNCH Project provided the written informed consent.