Table 1

ANC validation results

Indicator	Study	Client-reported (n)	Don’t know (n)	n	TP	FP	FN	TN	Observed (true) prevalence	Estimated prevalence	Sensitivity (95% CI)	Specificity (95% CI)	AUC (95% CI)	IF	Met both criteria?	No. studies both criteria met
Measure weight	BA	1035	0	1035	657	23	23	332	65.7	65.7	96.6 (95.0 to 97.8)	93.5 (90.4 to 95.8)	0.951 (0.94 to 0.97)	1.00	Y	*
	CA	958	0	949	828	54	40	27	91.5	92.9	95.4 (93.8 to 96.7)	33.3 (23.2 to 44.7)	0.644 (0.59 to 0.70)	1.02	N
	KE	779	1	776	717	17	18	24	94.7	94.6	97.6 (96.2 to 98.5)	58.5 (42.1 to 73.7)			NA
Blood pressure check	BA	1035	0	1035	907	19	18	91	89.4	89.5	98.1 (96.9 to 98.8)	82.7 (74.3 to 89.3)	0.904 (0.87 to 0.94)	1.00	Y	*
	CA	960	0	951	920	15	10	6	97.8	98.3	98.9 (98.0 to 99.5)	28.6 (11.3 to 52.2)			NA
	KE	1158	0	1156	1031	37	54	34	93.9	92.4	95.0 (93.6 to 96.2)	47.9 (35.9 to 60.1)	0.715 (0.66 to 0.77)	0.98	Y
Examine abdomen	BA	1035	5	1030	703	44	24	259	70.7	72.5	96.7 (95.2 to 97.9)	85.5 (81.0 to 89.2)	0.911 (0.89 to 0.93)	1.03	Y	*
	CA	959	0	950	733	79	49	90	82.3	85.4	93.7 (91.8 to 95.3)	53.6 (45.7 to 61.3)	0.737 (0.70 to 0.78)	1.04	Y
	KE	1158	0	1156	1086	23	38	9	97.2	95.9	96.6 (95.4 to 97.6)	28.1 (13.7 to 46.7)			NA
Check anaemia (pallor or refer to HB test)	BA	1035	0	1035	635	53	75	272	68.6	66.5	89.4 (86.9 to 91.6)	83.7 (79.2 to 87.5)	0.866 (0.84 to 0.89)	0.97	Y	*
	CA	957	0	948	375	127	101	345	50.2	52.9	78.8 (74.8 to 82.4)	73.1 (68.8 to 77.0)	0.759 (0.73 to 0.79)	1.05	Y
	KE	1157	17	1139	568	107	314	150	77.4	59.3	64.4 (61.1 to 67.6)	58.4 (52.1 to 64.5)	0.614 (0.58 to 0.65)	0.77	N
Check fetal heart rate	BA	1034	2	1032	508	56	58	410	54.8	54.6	89.8 (87.0 to 92.1)	88.0 (84.7 to 90.8)	0.889 (0.87 to 0.91)	1.00	Y	*
	CA	959	0	949	286	57	122	484	43.0	36.2	70.1 (65.4 to 74.5)	89.5 (86.6 to 91.9)	0.798 (0.77 to 0.82)	0.84	Y
	KE	1158	4	1152	946	105	46	55	86.1	91.2	95.4 (93.9 to 96.6)	34.4 (27.1 to 42.3)	0.649 (0.61 to 0.69)	1.06	N
Urine screen	BA	1032	0	1032	203	25	94	710	28.8	22.1	68.4 (62.7 to 73.6)	96.6 (95.0 to 97.8)	0.825 (0.80 to 0.85)	0.77	Y	*
	CA	956	0	947	1	31	4	911	0.5	3.4	20.0 (0.5 to 71.6)	96.7 (95.4 to 97.8)			NA
	KE	1157	0	1153	313	179	100	561	35.8	42.7	75.8 (71.4 to 79.8)	75.8 (72.6 to 78.9)	0.758 (0.73 to 0.78)	1.19	Y
Inform status of pregnancy	CA	956	0	947	190	300	98	359	30.4	51.7	66.0 (60.2 to 71.4)	54.5 (50.6 to 58.3)	0.602 (0.57 to 0.64)	1.70	N
Inform status of pregnancy	KE	1158	3	1153	790	201	107	55	77.8	85.9	88.1 (85.8 to 90.1)	21.5 (16.6 to 27.0)	0.548 (0.52 to 0.58)	1.10	N
Give return date	CA	955	0	945	793	58	62	32	90.5	90.1	92.7 (90.8 to 94.4)	35.6 (25.7 to 46.3)	0.642 (0.59 to 0.69)	1.00	N
Give return date	KE	1586	5	1149	991	36	104	18	95.3	89.4	90.5 (88.6 to 92.2)	33.3 (21.1 to 47.5)	0.619 (0.56 to 0.68)	0.94	N
Provider: nurse or midwife	BA	1036	0	1036	158	15	6	857	15.8	16.7	96.3 (92.2 to 98.6)	98.3 (97.2 to 99.0)	0.973 (0.96 to 0.99)	1.06	Y	*
Provider: nurse or midwife	KE	1158	0	1155	992	32	67	64	91.7	88.7	93.7 (92.0 to 95.1)	66.7 (56.3 to 76.0)	0.802 (0.75 to 0.85)	0.97	Y
Provider: doctor/medical officer	BA	1036	0	1036	466	7	17	546	46.6	45.6	96.5 (94.4 to 97.9)	98.7 (97.4 to 99.5)	0.976 (0.97 to 0.99)	0.98	Y	*
Provider: doctor/medical officer	KE	1158	0	1155	38	112	1	1004	3.4	13.0	97.4 (86.5 to 99.9)	90.0 (88.0 to 91.7)	0.937 (0.91 to 0.96)	3.83	N
Indicators measured in Bangladesh only
Take pulse	BA	1034	0	1022	281	103	58	580	33.2	37.6	82.9 (78.5 to 86.7)	84.9 (82.0 to 87.5)	0.839 (0.81 to 0.86)	1.13	Y	*
Check temperature	BA	1035	0	1035	236	63	87	649	31.2	28.9	73.1 (67.9 to 77.8)	91.2 (88.8 to 93.1)	0.821 (0.79 to 0.85)	0.93	Y	*
Vaginal examination	BA	1035	0	1031	11	24	13	983	2.3	3.4	45.8 (25.6 to 67.2)	97.6 (96.5 to 98.5)			NA
Perform/refer for blood test	BA	1034	0	1034	239	14	95	686	32.3	24.5	71.6 (66.4 to 76.3)	98.0 (96.7 to 98.9)	0.848 (0.82 to 0.87)	0.76	Y	*
Perform/refer for ultrasonogram	BA	1033	0	1033	143	16	113	761	24.8	15.4	55.9 (49.5 to 62.0)	97.9 (96.7 to 98.8)	0.769 (0.74 to 0.80)	0.62	N
Check oedema	BA	1035	0	1024	459	64	70	431	51.7	51.1	86.8 (83.6 to 89.5)	87.1 (83.8 to 89.9)	0.869 (0.85 to 0.89)	0.99	Y	*
Advise on diet/nutrition	BA	1034	0	1034	566	110	67	291	61.2	65.4	89.4 (86.8 to 91.7)	72.6 (67.9 to 76.9)	0.810 (0.78 to 0.83)	1.07	Y	*
Advise on TT injection	BA	1034	0	1034	448	89	70	427	50.1	51.9	86.5 (83.2 to 89.3)	82.8 (79.2 to 85.9)	0.846 (0.82 to 0.87)	1.04	Y	*
Discuss care for breasts/breast feeding	BA	485	0	483	24	22	14	423	7.9	9.5	63.2 (46.0 to 78.2)	95.1 (92.6 to 96.9)			NA
Inform on possible pregnancy-related complications	BA	1034	0	1034	121	265	38	610	15.4	37.3	76.1 (68.7 to 82.5)	69.7 (66.5 to 72.7)	0.729 (0.70 to 0.76)	2.51	N
Family welfare visitor attended ANC	BA	1036	0	1036	337	14	11	674	33.6	33.9	96.8 (94.4 to 98.4)	98.0 (96.6 to 98.9)	0.974 (0.96 to 0.98)	1.01	Y	*
Medical assistant attended ANC	BA	1036	0	1036	30	7	11	988	4.0	3.6	73.2 (57.1 to 85.8)	99.3 (98.6 to 99.7)	0.862 (0.79 to 0.93)	0.90	Y	*

Inflation factor (IF) is the ratio of estimated prevalence that would be obtained from a household survey applying the sensitivity and specificity to the prevalence observed in this study to the true (observed) prevalence.
Benchmark for high validity is AUC >0.7 and IF between 0.75 and 1.25.
See online supplementary tables 1 and 2 for indicator construction and differences across studies.
*Number of asterisks refers to number of studies where both criteria were met.
ANC, antenatal care; AUC, area under the receiver operating characteristic curve; BA, Bangladesh; CA, Cambodia; FN, false negative; FP, false positive; FWV, family welfare visitor; HB, haemoglobin; KE, Kenya; N, no; NA, not assessed; TN, true negative; TP, true positive; TT, tetanus toxoid; Y, yes.