Timing of antenatal care for adolescent and adult pregnant women in south-eastern Tanzania

Abstract

BackgroundEarly and frequent antenatal care attendance during pregnancy is important to identify and mitigate risk factors in pregnancy and to encourage women to have a skilled attendant at childbirth. However, many pregnant women in sub-Saharan Africa start antenatal care attendance late, particularly adolescent pregnant women. Therefore they do not fully benefit from its preventive and curative services. This study assesses the timing of adult and adolescent pregnant women's first antenatal care visit and identifies factors influencing early and late attendance.MethodsThe study was conducted in the Ulanga and Kilombero rural Demographic Surveillance area in south-eastern Tanzania in 2008. Qualitative exploratory studies informed the design of a structured questionnaire. A total of 440 women who attended antenatal care participated in exit interviews. Socio-demographic, social, perception- and service related factors were analysed for associations with timing of antenatal care initiation using regression analysis.ResultsThe majority of pregnant women initiated antenatal care attendance with an average of 5 gestational months. Belonging to the Sukuma ethnic group compared to other ethnic groups such as the Pogoro, Mhehe, Mgindo and others, perceived poor quality of care, late recognition of pregnancy and not being supported by the husband or partner were identified as factors associated with a later antenatal care enrolment (p < 0.05). Primiparity and previous experience of a miscarriage or stillbirth were associated with an earlier antenatal care attendance (p < 0.05). Adolescent pregnant women started antenatal care no later than adult pregnant women despite being more likely to be single.ConclusionsFactors including poor quality of care, lack of awareness about the health benefit of antenatal care, late recognition of pregnancy, and social and economic factors may influence timing of antenatal care. Community-based interventions are needed that involve men, and need to be combined with interventions that target improving the quality, content and outreach of antenatal care services to enhance early antenatal care enrolment among pregnant women.

Late initiation of antenatal care and its determinants: a hospital based cross-sectional study

“…27 However, a previous study conducted in Myanmar reported much lower gestational age at first ANC (15 weeks) while those detected in Ethiopian and Tanzanian studies were more than 20 weeks. 14,18,24 These discrepancies may be due to differences in time or site of study or differences in education and/or socioeconomic status among study population. Difference in culture or level of awareness on the significance of early initiation of ANC could explain these variations.…”

“…14,19 However, studies conducted in developed countries revealed lower proportions (4.4% to 27.3% % in USA, about 15% in UK and 41% in Australia) whereas some African studies reported comparable or higher values (53% in Ethiopia, 61.1% in Rwanda, 70.3% in Zambia, 81% in Nigeria, more than 70% in Tanzania and Malawi). 5,[16][17][18][20][21][22][23][24][25] Utilization of different cut-off points in defining late initiation of ANC could explain these discrepancies (first trimester or 12 completed weeks was used in USA and UK studies, 16 weeks in Ethiopian, Zambian, Tanzanian and Malawi studies, and second/third trimester in some studies). 5,[16][17][18][19][20]22,24,25 The proportions of pregnant women who initiate ANC before 4 months of gestation among neighboring and ASEAN countries were 40.4% in Bangladesh, 32.2% in Cambodia, 56.9% in India, 78.6% in Indonesia, 37.5% in Nepal, 46.9% in Pakistan, 56.1% in the Philippines and 65% in Vietnam.…”

“…5,[16][17][18][20][21][22][23][24][25] Utilization of different cut-off points in defining late initiation of ANC could explain these discrepancies (first trimester or 12 completed weeks was used in USA and UK studies, 16 weeks in Ethiopian, Zambian, Tanzanian and Malawi studies, and second/third trimester in some studies). 5,[16][17][18][19][20]22,24,25 The proportions of pregnant women who initiate ANC before 4 months of gestation among neighboring and ASEAN countries were 40.4% in Bangladesh, 32.2% in Cambodia, 56.9% in India, 78.6% in Indonesia, 37.5% in Nepal, 46.9% in Pakistan, 56.1% in the Philippines and 65% in Vietnam. 26 Differences in culture or socioeconomic status or health knowledge including awareness on the importance of early booking for ANC or education level among study populations, or differences in time of study or study area whether urban or rural may also be responsible.…”

Barriers to Antenatal Care in an Urban Community in the Gambia: An In-depth Qualitative Interview Study

“…Previous reports from throughout sub-Saharan Africa have recognized some of these barriers, but a number of these studies have been quantitative surveys. It is interesting to note that when a structured questionnaire 4,11,12,14,15 is used there is more emphasis on the practical barriers to attendance whereas the more open-ended, lessconstrained approach with a qualitative study 5,[6][7][8]10 enables the identification of additional and more complex barriers. During the first three months the barriers are almost entirely identified by qualitative studies.…”

“…Throughout sub-Saharan Africa, in addition to social taboos, there is evidence that women are unsure of the purpose behind antenatal care 7 , probably due to a belief that childbearing represents a normal ‗bodily experience' rather than an illness 8 . Practical barriers to using antenatal care include remoteness from treatment facilities and costs [9][10][11] , a belief that attendance is necessary to obtain a document that permits delivery within the hospital 8 , and the attitude of health professionals [12][13][14][15] . The barriers to antenatal care remain unstudied in an urban context.…”