Analysis of dropout across the continuum of maternal health care in Tanzania: findings from a cross-sectional household survey

Abstract

The 'continuum of care' is proposed as a key framework for the delivery of maternal, neonatal and child health services. This study examined the extent of dropout as well as factors associated with retention across the MNCH continuum from antenatal care (ANC), through skilled birth attendance (SBA), to postnatal care (PNC).We analyzed data from 1931 women who delivered in the preceding 2-14 months, from a two-stage cluster sampling household survey in four districts of Tanzania's Morogoro region. The survey was conducted in 2011 as a part of a baseline for an independent evaluation of a maternal health program. Using the Anderson model of health care seeking, we fitted logistic models for three transition stages in the continuum.Only 10% of women received the 'recommended' care package (4+ ANC visits, SBA, and 1+ PNC visit), while 1% reported not having care at any stage. Receipt of four ANC visits was positively associated with women being older in age (age 20-34 years-OR: 1.77, 95%CI: 1.22-2.56; age 35-49 years-2.03, 1.29-3.2), and knowledge of danger signs (1.75, 1.39 -2.1). A pro-rich bias was observed in facility-based deliveries (proxy for SBA), with women from the fourth (1.66, 1.12-2.47) and highest quintiles of household wealth (3.4, 2.04-5.66) and the top tertile of communities by wealth (2.9, 1.14-7.4). Higher rates of facility deliveries were also reported with antenatal complications (1.37, 1.05-1.79), and 4+ ANC visits (1.55, 1.14-2.09). Returning for PNC was highest among the wealthiest communities (2.25, 1.21-4.44); catchment areas of a new PNC program (1.89, 1.03-3.45); knowledge of danger signs (1.78, 1.13-2.83); community health worker counselling (4.22, 1.97-9.05); complicated delivery (3.25, 1.84-5.73); and previous health provider counselling on family planning (2.39, 1.71-3.35).Dropout from maternal care continuum is high, especially for the poorest, in rural Tanzania. Interactions with formal health system and perceived need for future services appear to be important factors for retention.

Level of completion along continuum of care for maternal and child health services and factors associated with it among women in Arba Minch Zuria Woreda, Gamo Zone, Southern Ethiopia: a community based cross-sectional study

“…In this study the level of continuum of care was 9.7%[95% CI: 6.9%, 12.5%] which is consistent with findings from study in Tanzania (10%) [17] but higher than study conducted in Cambodia (5%) [23], and lower than studies conducted in Pakistan (27%) and Egypt (50.3%) [21,22]. The possible reason in this study might be due to time variation, variation in study design, and variation in source of data.…”

“…Women were classified as not completed the continuum of care if they missed any one of the above visits/attendances at any level. [17,[21][22][23].…”

“…Time for first ANC visit: the time or gestational period at which the pregnant women first attend ANC clinic was classified as in the first trimester or after first trimester [24,25]. Knowledge on key pregnancy danger signs: women were classified as knowledgeable if they mentioned at least two of the four key danger signs of pregnancy (vaginal bleeding, severe headache, blurring of vision and feet or face swelling) if not they were classified as not knowledgeable [17].…”

“…The completion in the continuum of care has outweighing advantages over separate cares or intervention because each stage of continuum of care builds on the success of the previous stages [11][12][13][14][15][16]. However, evidences from the globe suggest that women completing the continuum of care for maternal and child health services are very low and women do not access MNCH services serially along continuum of care [17][18][19].…”

Maternal and newborn health implementation research: programme outcomes, pathways of change and partnerships for equitable health systems in Uganda

“…Progress is also constrained by barriers to accessing healthcare for women and children that interact across health-system levels and increase across the continuum of care [4][5][6]. Once the need for healthcare seeking is recognized, lack of preparedness to mobilize transport, funds, family and community support can delay access to care.…”