Factors Associated with Four or More Antenatal Care Visits and Its Decline among Pregnant Women in Tanzania between 1999 and 2010

In Tanzania, the coverage of four or more antenatal care (ANC 4) visits among pregnant women has declined over time. We conducted an exploratory analysis to identify factors associated with utilization of ANC 4 and ANC 4 decline among pregnant women over time. We used data from 8035 women who delive...

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Published in:PloS one Vol. 9; no. 7; p. e101893
Main Authors: Gupta, Shivam, Yamada, Goro, Mpembeni, Rose, Frumence, Gasto, Callaghan-Koru, Jennifer A., Stevenson, Raz, Brandes, Neal, Baqui, Abdullah H.
Format: Journal Article
Language:English
Published: United States Public Library of Science 18.07.2014
Public Library of Science (PLoS)
Subjects:
Adult
Analysis
Demographics
Demography
Female
Geography
Health care facilities
Health services
HIV tests
Humans
Income - statistics & numerical data
Insurance Coverage - statistics & numerical data
Low income groups
Malaria
Maternal & child health
Medicine
Medicine and Health Sciences
Middle Aged
Patient Acceptance of Health Care - statistics & numerical data
Pregnancy
Pregnant women
Prenatal care
Prenatal Care - economics
Prenatal Care - statistics & numerical data
Prenatal Care - trends
Public health
Public Health - statistics & numerical data
Pyrimethamine
Regression analysis
Regression models
Research and Analysis Methods
Science
Social Sciences
Surveys
Tanzania
Utilization
Vector-borne diseases
Womens health
Young Adult
Tanzania
Uganda
United States > US
Maryland
Baltimore Maryland
ISSN:1932-6203, 1932-6203
Online Access:Get full text
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Summary:In Tanzania, the coverage of four or more antenatal care (ANC 4) visits among pregnant women has declined over time. We conducted an exploratory analysis to identify factors associated with utilization of ANC 4 and ANC 4 decline among pregnant women over time. We used data from 8035 women who delivered within two years preceding Tanzania Demographic and Health Surveys conducted in 1999, 2004/05 and 2010. Multivariate logistic regression models were used to examine the association between all potential factors and utilization of ANC 4; and decline in ANC 4 over time. Factors positively associated with ANC 4 utilization were higher quality of services, testing and counseling for HIV during ANC, receiving two or more doses of SP (Sulphadoxine Pyrimethamine)/Fansidar for preventing malaria during ANC and higher educational status of the woman. Negatively associated factors were residing in a zone other than Eastern zone, never married woman, reported long distance to health facility, first ANC visit after four months of pregnancy and woman's desire to avoid pregnancy. The factors significantly associated with decline in utilization of ANC 4 were: geographic zone and age of the woman at delivery. Strategies to increase ANC 4 utilization should focus on improvement in quality of care, geographic accessibility, early ANC initiation, and services that allow women to avoid pregnancy. The interconnected nature of the Tanzanian Health System is reflected in ANC 4 decline over time where introduction of new programs might have had unintended effects on existing programs. An in-depth assessment of the recent policy change towards Focused Antenatal Care and its implementation across different geographic zones, including its effect on the perception and understanding among women and performance and counseling by health providers can help explain the decline in ANC 4.
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Conceived and designed the experiments: SG GY RM GF JC RS NB AHB. Analyzed the data: GY SG AHB. Wrote the paper: SG GY RM JC AHB. Interpretation and critical review: SG GY RM GF JC RS NB AHB.
Competing Interests: The authors have declared that no competing interests exist.
ISSN:1932-6203
1932-6203
DOI:10.1371/journal.pone.0101893