{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,18]],"date-time":"2026-08-18T16:33:10Z","timestamp":1787070790598,"version":"build-2736575974"},"reference-count":15,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"3","license":[{"start":{"date-parts":[[2025,2,1]],"date-time":"2025-02-01T00:00:00Z","timestamp":1738368000000},"content-version":"unspecified","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-sa\/4.0"}],"content-domain":{"domain":["lww.com","ovid.com"],"crossmark-restriction":true},"short-container-title":[],"published-print":{"date-parts":[[2025,5]]},"abstract":"<jats:sec>\n                    <jats:title>Introduction:<\/jats:title>\n                    <jats:p>Quality antenatal care (QANC) is an important health care indicator of the public health structure of the country. Causal mediation analysis is a statistical model that can model the complex path that determines the QANC received by women. The objective of the study was to assess the proportion of women receiving QANC in India and to ascertain its determinants using causal mediation analysis.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methodology:<\/jats:title>\n                    <jats:p>The dataset for study was obtained from the NFHS-4 survey. The outcome variable QANC was formulated based on a set working definition. The potential determinants of QANC at individual and population levels were identified by literature search, expert opinion, and availability in the NFHS dataset. The effect estimates of the determinants were estimated by multiple logistic regression. The potential determinant variables were categorized as independent and mediating variables. A schematic path analysis model was conceptualized by plausibility and expert opinion. The direct, indirect, and total effects of independent and mediating variables were estimated by generalized causal path analysis.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results:<\/jats:title>\n                    <jats:p>We found that region, education, wealth, religion, working status, husband\u2019s education, and age were significant independent factors influencing QANC. Additionally, we found that husband\u2019s alcohol status, pregnancy awareness month, presence of husband during antenatal care (ANC) visit, pregnancy registration month, emotional violence, and timing of the first ANC visit were significant mediating variables.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion:<\/jats:title>\n                    <jats:p>Understanding the factors associated with QANC is statistically more robust using causal path analysis, which would help us better shape policies for improved maternal health care in India.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.4103\/ijcm.ijcm_810_23","type":"journal-article","created":{"date-parts":[[2025,2,3]],"date-time":"2025-02-03T02:00:17Z","timestamp":1738548017000},"page":"428-436","update-policy":"https:\/\/doi.org\/10.1097\/lww.0000000000001000","source":"Crossref","is-referenced-by-count":2,"title":["Determinants of Quality Antenatal Care in Pregnant Women Using NFHS-4 Data: A Path Analysis Approach"],"prefix":"10.4103","volume":"50","author":[{"given":"Sachit","family":"Ganapathy","sequence":"first","affiliation":[{"name":"Department of Biostatistics, Jawaharlal Institute of Post Graduate Medical Education and Research (JIPMER), Puducherry, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bhanushree","family":"Soni","sequence":"additional","affiliation":[{"name":"Department of Preventive and Social Medicine, Jawaharlal Institute of Post Graduate Medical Education and Research (JIPMER), Puducherry, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Akash","family":"Mishra","sequence":"additional","affiliation":[{"name":"Department of Community Medicine, Division of Biostatistics, Mahatma Gandhi Medical College and Hospital, Jaipur, Rajasthan, India"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","published-online":{"date-parts":[[2025,2,1]]},"reference":[{"key":"R2-20260423","article-title":"Seeing the Unseen","author":"McFarlane","year":"2022","journal-title":"UNFPA"},{"key":"R5-20260423","doi-asserted-by":"crossref","first-page":"417","DOI":"10.1016\/S0140-6736(07)61693-6","article-title":"What works? Interventions for maternal and child undernutrition and survival","volume":"371","author":"Bhutta","year":"2008","journal-title":"Lancet Lond Engl"},{"key":"R6-20260423","doi-asserted-by":"crossref","first-page":"367","DOI":"10.1016\/S2352-4642(20)30274-1","article-title":"Effective interventions to address maternal and child malnutrition: An update of the evidence","volume":"5","author":"Keats","year":"2021","journal-title":"Lancet Child Adolesc Health"},{"key":"R7-20260423","doi-asserted-by":"crossref","first-page":"684.","DOI":"10.1186\/s12913-019-4476-4","article-title":"Quality of antenatal care and associated factors in a rural county in Kenya: An assessment of service provision and experience dimensions","volume":"19","author":"Afulani","year":"2019","journal-title":"BMC Health Serv Res"},{"issue":"Suppl 4","key":"R8-20260423","doi-asserted-by":"crossref","first-page":"7","DOI":"10.1111\/1471-0528.15825","article-title":"Measuring quality of antenatal care: A secondary analysis of national survey data from India","volume":"126","author":"Singh","year":"2019","journal-title":"BJOG"},{"key":"R12-20260423","doi-asserted-by":"crossref","first-page":"3152.","DOI":"10.3390\/ijerph16173152","article-title":"Enablers and barriers to the utilization of antenatal care services in India","volume":"16","author":"Ogbo","year":"2019","journal-title":"Int J Environ Res Public Health"},{"key":"R13-20260423","first-page":"31","article-title":"Ministry of Health and Family Welfare, Government of India","journal-title":"(National Health Policy). Report No.: 3"},{"key":"R16-20260423","doi-asserted-by":"crossref","first-page":"20503121211058056.","DOI":"10.1177\/20503121211058055","article-title":"Quality of antenatal care and associated factors among pregnant women attending government hospitals in Sidama Region, Southern Ethiopia","volume":"9","author":"Kare","year":"2021","journal-title":"SAGE Open Med"},{"key":"R17-20260423","doi-asserted-by":"crossref","first-page":"94.","DOI":"10.1186\/1471-2393-14-94","article-title":"Factors associated with the use and quality of antenatal care in Nepal: A population-based study using the demographic and health survey data","volume":"14","author":"Joshi","year":"2014","journal-title":"BMC Pregnancy Childbirth"},{"key":"R18-20260423","doi-asserted-by":"crossref","first-page":"467","DOI":"10.15171\/ijhpm.2019.28","article-title":"Regular antenatal care visits predict good knowledge among post-natal mothers regarding entitlements of health programs in Western India","volume":"8","author":"Rupani","year":"2019","journal-title":"Int J Health Policy Manag"},{"key":"R19-20260423","doi-asserted-by":"crossref","first-page":"754.","DOI":"10.1186\/s12884-021-04230-5","article-title":"Intimate partner violence as a predictor of antenatal care services utilization in Rwanda","volume":"21","author":"Bahati","year":"2021","journal-title":"BMC Pregnancy Childbirth"},{"key":"R20-20260423","doi-asserted-by":"crossref","first-page":"280","DOI":"10.1097\/00004010-200610000-00003","article-title":"Using path analysis to examine causal relationships among balanced scorecard performance indicators for general hospitals: The case of a public hospital system in Taiwan","volume":"31","author":"Yang","year":"2006","journal-title":"Health Care Manage Rev"},{"key":"R21-20260423","doi-asserted-by":"crossref","first-page":"463","DOI":"10.1016\/S2352-4642(19)30110-5","article-title":"Social, biological, and programmatic factors linking adolescent pregnancy and early childhood undernutrition: A path analysis of India\u2019s 2016 National Family and Health Survey","volume":"3","author":"Nguyen","year":"2019","journal-title":"Lancet Child Adolesc Health"},{"key":"R22-20260423","doi-asserted-by":"crossref","first-page":"25","DOI":"10.1111\/j.1600-0528.2004.00190.x","article-title":"The social determinants of oral health: New approaches to conceptualizing and researching complex causal networks","volume":"33","author":"Newton","year":"2005","journal-title":"Community Dent Oral Epidemiol"},{"key":"R23-20260423","doi-asserted-by":"crossref","first-page":"87.","DOI":"10.3390\/resources7040087","article-title":"A relationship of causal factors in the economic, social, and environmental aspects affecting the implementation of sustainability policy in Thailand: Enriching the path analysis based on a GMM Model","volume":"7","author":"Sutthichaimethee","year":"2018","journal-title":"Resources"}],"container-title":["Indian Journal of Community Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.ovid.com\/10.4103\/ijcm.ijcm_810_23","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,8,18]],"date-time":"2026-08-18T15:36:39Z","timestamp":1787067399000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.ovid.com\/10.4103\/ijcm.ijcm_810_23"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,2,1]]},"references-count":15,"journal-issue":{"issue":"3","published-print":{"date-parts":[[2025]]}},"URL":"https:\/\/doi.org\/10.4103\/ijcm.ijcm_810_23","relation":{},"ISSN":["0970-0218","1998-3581"],"issn-type":[{"value":"0970-0218","type":"print"},{"value":"1998-3581","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,2,1]]},"assertion":[{"value":"2023-12-07","name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2024-05-15","name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}}]}}