Receiving antenatal care components and associated factors in Northwestern Tanzania

Abstract

Introduction Tanzania had an estimated 5.400 maternal deaths in 2020. Suboptimal quality of antenatal care (ANC) presents a major challenge. It is not known what precisely the uptake of the various ANC components is, such as counseling on birth preparedness and complication readiness, preventive measures and screening tests. We assessed the level of receiving the various ANC components and associated factors in order to identify opportunities to improve ANC. Methods A cross-sectional household survey using a structured questionnaire through face-to-face interviews, was conducted in April 2016 in Mara and Kagera regions, Tanzania, applying a two-stage, stratified-cluster sampling design. The analysis included 1,162 women aged 15–49 years who attended ANC during their last pregnancy and had given birth not longer than two years prior to the survey. To account for inter- and intra-cluster variations, we used mixed-effect logistic regression to examine factors associated with receiving essential ANC components: counseling around birth preparedness and complication readiness (with presumed effects on knowledge about danger signs) and preventive measures. Results About In 878 (76.1%) women preparedness for birth and its complications was observed to exist. Overall counseling was low where 902 (77.6%) women received adequate counseling. Overall knowledge of danger signs was low in 467 women (40.2%). Uptake of preventive measures was low, with presumptive malaria treatment in 828 (71.3%) and treatment of intestinal worms in 519 (44.7%) women. Screening test levels varied for HIV in 1,057 (91.2%), any blood pressure measurement in 803 (70.4%), syphilis in 367 (32.2%) and tuberculosis in 186 (16.3%) women. After adjusting for age, wealth and parity, the likelihood of receiving adequate counseling on essential topics was less in women without education versus primary education (aOR 0.64; 95% CI 0.42–0.96) and in women who had <4 ANC visits versus ≥4 visits (aOR 0.57; 95% CI 0.40–0.81). Receiving care in privacy or not (aOR 2.01; 95% CI 1.30–3.12) and having secondary education as compared to primary education (aOR 1.92; 95% CI 1.10–3.70) were associated with receiving adequate counseling. Odds of receiving adequate care in at least one ANC visit were lower in women with joint decision making on major purchases versus decision making by male partner or other family members alone (aOR 0.44; 95% CI 0.24–0.78), similar to being less knowledgeable on danger signs (aOR 0.70; 95% CI 0.51–0.96). Conclusion Overall uptake of various essential ANC components was low. Frequent ANC visits and ensuring privacy are all essential to improve the uptake of ANC.

The Adequacy of ANC services received and associated factors among Women of Reproductive Age in Tanzania

“…In Tanzania, the maternal mortality ratio is estimated at 104 deaths per 100,000 live births (4). The slow reduction of maternal mortality in Tanzania continues to threaten the achievement of the global agendas of reducing maternal mortality to 70 deaths per 100,000 live births by 2030 as per Sustainable Development Goal 3.1(5) (6). Inadequate uptake of the ANC services and variation around low and middle income countries has led to stagnation in reduction of maternal mortality rate in various areas of the country and pregnancy related complications such as preeclampsia and GDM also resulting into poor childbirth outcomes(1,7,8).…”

“…The proportion of women with overall adequate ANC ranged from 9.6% in Uganda (10), 11% and 19.6% in Ethiopia (11,12) to 21% in Bangladesh (14). Studies from Tanzania, Kenya, and Rwanda have revealed inadequate counseling during ANC, with just 68% of women receiving advice on birth preparedness, 55% on risk indications, 41% on family planning after childbirth, and 17% on nutrition (6). In Tanzania inadequate ANC was reported in a rural district in eastern-central, where hemoglobin was measured in 22 % to 37 % of women and Blood pressure measurement was most common service provided to about 69% and 87% of women attending ANC (14)(15)(16)(17) with the lowest coverage being urine sample taken (18,19).…”