title: Women's experiences and views about costs of seeking malaria chemoprevention and other antenatal services: a qualitative study from two districts in rural Tanzania.
abstract: BACKGROUND
  The Tanzanian government recommends women who attend antenatal care (ANC) clinics to accept receiving intermittent preventive treatment against malaria during pregnancy (IPTp) and vouchers for insecticide-treated nets (ITNs) at subsidized prices. Little emphasis has been paid to investigate the ability of pregnant women to access and effectively utilize these services.
  
  
  OBJECTIVE
  To describe the experience and perceptions of pregnant women about costs and cost barriers for accessing ANC services with emphasis on IPTp in rural Tanzania.
  
  
  METHODS
  Qualitative data were collected in the districts of Mufindi in Iringa Region and Mkuranga in Coast Region through 1) focus group discussions (FGDs) with pregnant women and mothers to infants and 2) exit-interviews with pregnant women identified at ANC clinics. Data were analyzed manually using qualitative content analysis methodology.
  
  
  RESULTS
  FGD participants and interview respondents identified the following key limiting factors for women's use of ANC services: 1) costs in terms of money and time associated with accessing ANC clinics, 2) the presence of more or less official user-fees for some services within the ANC package, and 3) service providers' application of fines, penalties and blame when failing to adhere to service schedules. Interestingly, the time associated with travelling long distances to ANC clinics and ITN retailers and with waiting for services at clinic-level was a major factor of discouragement in the health seeking behaviour of pregnant women because it seriously affected their domestic responsibilities.
  
  
  CONCLUSIONS
  A variety of resource-related factors were shown to affect the health seeking behaviour of pregnant women in rural Tanzania. Thus, accessibility to ANC services was hampered by direct and indirect costs, travel distances and waiting time. Strengthening of user-fee exemption practices and bringing services closer to the users, for example by promoting community-directed control of selected public health services, including IPTp, are urgently needed measures for increasing equity in health services in Tanzania.
authors.affiliation: National Institute for Medical Research, Centre for Enhancement of Effective Malaria Interventions, Dar es Salaam, Tanzania. gmmubyazi@yahoo.co.uk
authors.forename: Godfrey M
authors.initials: GM
authors.lastname: Mubyazi
authors.forename: Paul
authors.initials: P
authors.lastname: Bloch
authors.forename: Pascal
authors.initials: P
authors.lastname: Magnussen
authors.forename: Øystein E
authors.initials: ØE
authors.lastname: Olsen
authors.forename: Jens
authors.initials: J
authors.lastname: Byskov
authors.forename: Kristian S
authors.initials: KS
authors.lastname: Hansen
authors.forename: Ib C
authors.initials: IC
authors.lastname: Bygbjerg
mesh_terms: D000328:Adult; D000962:Antimalarials / Q000191:economics / Q000627:therapeutic use*; D003430:Cross-Sectional Studies; D005249:Fees and Charges; D005260:Female; D017144:Focus Groups; D005102:Health Expenditures; D007722:Health Knowledge, Attitudes, Practice; D006297:Health Services Accessibility / Q000191:economics; D006801:Humans; D016778:Malaria, Falciparum / Q000188:drug therapy / Q000453:epidemiology / Q000517:prevention & control*; D008427:Maternal Health Services / Q000706:statistics & numerical data; D010342:Patient Acceptance of Health Care; D017060:Patient Satisfaction; D011247:Pregnancy; D015597:Pregnancy Complications, Parasitic / Q000188:drug therapy / Q000517:prevention & control*; D011295:Prenatal Care / Q000191:economics* / Q000706:statistics & numerical data; D036301:Qualitative Research; D012424:Rural Population; D013636:Tanzania; D013997:Time Factors
chemical_list: D000962:Antimalarials