Missed opportunities in antenatal care for improving the health of pregnant women and newborns in Geita district, Northwest Tanzania

Abstract

BackgroundDespite the significant benefits of early detection and management of pregnancy related complications during antenatal care (ANC) visits, not all pregnant women in Tanzania initiate ANC in a timely manner. The primary objectives of this research study in rural communities of Geita district, Northwest Tanzania were: 1) to conduct a population-based study that examined the utilization and availability of ANC services; and 2) to explore the challenges faced by women who visited ANC clinics and barriers to utilization of ANC among pregnant women.MethodsA sequential explanatory mixed method design was utilized. Household surveys that examined antenatal service utilization and availability were conducted in 11 randomly selected wards in Geita district. One thousand, seven hundred and nineteen pregnant women in their 3rd trimester participated in household surveys. It was followed by focus group discussions with community health workers and pregnant women that examined challenges and barriers to ANC.ResultsOf the pregnant women who participated, 86.74% attended an ANC clinic at least once; 3.62% initiated ANC in the first trimester; 13.26% had not initiated ANC when they were interviewed in their 3rd trimester. Of the women who had attended ANC at least once, the majority (82.96%) had been checked for HIV status, less than a half (48.36%) were checked for hemoglobin level, and only a minority had been screened for syphilis (6.51%). Among women offered laboratory testing, the prevalence of HIV was 3.88%, syphilis, 18.57%, and anemia, 54.09%. In terms of other preventive measures, 91.01% received a tetanus toxoid vaccination, 76.32%, antimalarial drugs, 65.13%, antihelminthic drugs, and 76.12%, iron supplements at least once. Significant challenges identified by women who visited ANC clinics included lack of male partner involvement, informal regulations imposed by health care providers, perceived poor quality of care, and health care system related factors. Socio-cultural beliefs, fear of HIV testing, poverty and distance from health clinics were reported as barriers to early ANC utilization.ConclusionAccess to effective ANC remains a challenge among women in Geita district. Notably, most women initiated ANC late and early initiation did not guarantee care that could contribute to better pregnancy outcomes.Electronic supplementary materialThe online version of this article (10.1186/s12884-018-2014-8) contains supplementary material, which is available to authorized users.

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“…Syphilis infection is one of the most common maternal factors related to stillbirth, particularly in lowincome and middle-income countries, not only because it is not rare [19], but also because of the low detection rate of syphilis during pregnancy [20]. Focusing on syphilis produced an 80% reduction in stillbirths, which performs better than strategies to prevent malaria, HIV, and bacterial vaginosis infections in pregnant women in developing countries [21].…”

Predictors of the Timing and Number of Antenatal Care Visits among Unmarried Compared To Married Youth in Uganda Between 1995 And 2011

“…On the other hand, late ANC start has been observed to be associated with poor pregnancy outcomes like low birth weight and pre-mature births (19). Timely and frequent ANC benefits include provision of preventive health services such as vaccination, malaria prophylaxis, iron supplementation, nutrition counselling, and HIV counselling and testing (14,(20)(21)(22). Antenatal use also influences the use of subsequent maternal health services, such as delivery in the health facilities, or under the supervision of the trained birth attendant (21,(23)(24)(25)(26)(27)(28)(29)(30)(31), and postnatal check-ups (26)(27)(28)(29)(31)(32)(33).…”

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