Nurse-Delivered Antenatal Care Utilization and Maternal Biomarkers in a Conflict-Affected Health System: A Cross-Sectional Study from Yemen with Implications for Nursing Regulation

This project contains all supplementary materials supporting the manuscript titled above, which investigates the association between nurse-delivered antenatal care (ANC) utilization and objective maternal health biomarkers in conflict-affected Yemen. The study was conducted in four public health facilities in Al-Dhalea Governorate between June and October 2025, enrolling 422 pregnant and recently delivered women. The primary aim was to generate robust, policy-relevant empirical evidence to inform nursing regulatory frameworks, scope-of-practice decisions, and minimum competency standards for antenatal care in fragile health systems. Key Findings Summary · Women with adequate nurse-delivered ANC (≥4 visits) had significantly higher mean hemoglobin (12.18 vs. 10.64 g/dL, p < 0.001) and serum ferritin levels (37.12 vs. 28.34 ng/mL, p < 0.001). · Proteinuria prevalence was substantially lower among women with adequate ANC (12.2% vs. 48.2%, p < 0.001). · Higher education (aOR = 7.89), shorter distance to facilities (aOR = 0.76 per km), family support (aOR = 3.45), and satisfaction with nursing care (aOR = 5.67) were significant predictors of adequate ANC attendance. · Path analysis confirmed significant direct associations between ANC utilization and improved hematological profiles (CFI = 0.94, RMSEA = 0.045). Laboratory Methods All laboratory investigations were performed at participating health centers following standard operating procedures. Key parameters included: · Hemoglobin: Cyanmethemoglobin method (HemoCue® 301) · Serum Ferritin: ELISA (Human Ferritin ELISA Kit) · Urine Protein: Dipstick (Multistix® 10 SG) · WBC and Platelets: Manual counting with improved Neubauer chamber (inter-facility CV: 6.8% for WBC, 11.2% for platelets) Detailed laboratory methodology and quality control procedures are available in File S14.