Factors Associated With Changes in Adequate Antenatal Care Visits Among Pregnant Women Aged 15-49 Years in Tanzania From 2004 to 2016

ELIZABETH KASAGAMA Kilimanjaro Christian Medical University College kasagamae93@mail.comCorresponding Author ORCiD: https://orcid.org/0000-0002-9900-4153 Jim Todd London School of Hygiene and Tropical Medicine Jenny Renju London School of Hygiene and Tropical Medicine
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Background:Antenatal care (ANC) is crucial for the health of the mother and the unborn child as it delivers highly–effective health interventions that can prevent maternal and newborn deaths and morbidity. In 2002,the World Health Organization (WHO) recommended a minimum of four ANC visits for a pregnantwoman with a positive pregnancy during the entire gestational period. Tanzania has sub-optimaladequate (four or more) ANC visits and the trend has been fluctuating over time. An understanding ofthe factors associated with changes in adequate ANC visits over years is crucial in improving theproportions of pregnant women attaining adequate ANC visits in Tanzania.

MethodsThe study used secondary data from Tanzania Demographic Health Survey (TDHS) from 2004 to2016. The study included 17976 women aged 15–49 years. Data were analyzed using stata version13. Categorical and continuous variables were summarized using descriptive statistics and using theweighted proportions. A Poisson regression analysis was done to determine factors associated withadequate antenatal. A multivariable Poisson decomposition analysis was done to determine factorsassociated with changes in adequate ANC visits among pregnant women in Tanzania from 2004 to 2016.

ResultsThe overall proportion of women who had adequate ANC visits in 2004/05, 2010 and 2015/16 was62%, 43% and 51% respectively. The identified determinants of adequate ANC visits were: early ANCinitiation, zones, having more than one child, being aged 20 years and above, wanting pregnancylater, belonging to a richer and richest wealth quintile, having secondary and higher education,reporting distance to health facility not a big problem and watching TV at least once per week.Comparing 2004/05 and 2010 surveys, changes in the population structure contributed 4.2% ofchanges in adequate antenatal care visits while changes in coefficients contributed 95.8% of thechanges. Also, comparing 2015/16 to 2010 surveys, changes in population structure and coefficientscontributed 66.2% and 33.8% respectively.

ConclusionEarly ANC initiation has greatly contributed to increased proportion of pregnant women who attain3four or more ANC visits overtime. More effort should focus on pregnant women to initiate ANC in thefirst trimester in order to increase proportion of women with adequate ANC visit.