title: Factors associated with four or more antenatal care visits and its decline among pregnant women in Tanzania between 1999 and 2010.
abstract: 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.
authors.affiliation: Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America.
authors.forename: Shivam
authors.initials: S
authors.lastname: Gupta
authors.affiliation: Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America.
authors.forename: Goro
authors.initials: G
authors.lastname: Yamada
authors.affiliation: Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania.
authors.forename: Rose
authors.initials: R
authors.lastname: Mpembeni
authors.affiliation: Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania.
authors.forename: Gasto
authors.initials: G
authors.lastname: Frumence
authors.affiliation: Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America.
authors.forename: Jennifer A
authors.initials: JA
authors.lastname: Callaghan-Koru
authors.affiliation: United States Agency for International Development, Dar es Salaam, Tanzania.
authors.forename: Raz
authors.initials: R
authors.lastname: Stevenson
authors.affiliation: United States Agency for International Development, Washington, District of Columbia, United States of America.
authors.forename: Neal
authors.initials: N
authors.lastname: Brandes
authors.affiliation: Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America.
authors.forename: Abdullah H
authors.initials: AH
authors.lastname: Baqui
mesh_terms: D000328:Adult; D005260:Female; D005843:Geography; D006801:Humans; D007182:Income / Q000706:statistics & numerical data; D019458:Insurance Coverage / Q000706:statistics & numerical data; D008875:Middle Aged; D010342:Patient Acceptance of Health Care / Q000706:statistics & numerical data; D011247:Pregnancy; D011295:Prenatal Care / Q000191:economics / Q000706:statistics & numerical data / Q000639:trends*; D011634:Public Health / Q000706:statistics & numerical data; D013636:Tanzania; D055815:Young Adult