On the way to universal coverage of maternal services in Iringa rural District in Tanzania. Who is yet to be reached?
BACKGROUND
Strategies to tackle maternal mortality in sub-Saharan Africa include expanding coverage of reproductive services. Even where high, more vulnerable women may not access services. No data is available on high coverage determinants. We investigated this in Tanzania in a predicted high utilization area.


METHODS
Data was collected through a household survey of 464 women with a recent delivery. Primary outcomes were facility delivery and ≥4 ANC visits. Determinants were analysed using multivariate regression.


RESULTS
Almost all women had attended ANC, though only 58.3% had ≥4 visits. ≥4 visits were more likely in the youngest age group (OR 2.7 95% CI 1.32-5.49, p=0.008), and in early ANC attenders (OR 3.2 95% CI 2.04-4.90, p<0.001). Facility delivery was greater than expected (87.7%), more likely in more educated women (OR 2.7 95% CI 1.50-4.75, p=0.002), in those within 5 kilometers of a facility (OR 3.2 95% CI 1.59-6.48, p=0.002), and for early ANC attenders (OR 2.4 95% CI 1.20-4.91, p=0.02).


CONCLUSIONS
Rural contexts can achieve high facility delivery coverage. Based on our findings, strategies to reach women yet unserved should include promotion of early ANC start particularly for the less educated, and improvement of distant communities' access to facilities.
Doctors with Africa-CUAMM, Tanzania.
Manuela
M
Straneo
Doctors with Africa-CUAMM, Tanzania.
Piera
P
Fogliati
Doctors with Africa-CUAMM, Tanzania.
Ingrid
I
Pellis
London School of Hygiene and Tropical Medicine.
Catherine
C
Goodman
Doctors with Africa-CUAMM, Tanzania.
Donata Dalla
DD
Riva
Iringa District Council, Reproductive and Child Health, District Medical Office.
Firma
F
Kisika
Regional Medical Office, Iringa Region.
Ezekiel
E
Mpuya
Doctors with Africa-CUAMM, Tanzania.
Giovanni
G
Putoto
D000328:Adult; D003430:Cross-Sectional Studies; D036861:Delivery, Obstetric / Q000706:statistics & numerical data*; D003906:Developing Countries; D005260:Female; D006297:Health Services Accessibility / Q000706:statistics & numerical data; D006301:Health Services Needs and Demand; D006801:Humans; D008427:Maternal Health Services / Q000706:statistics & numerical data*; D008428:Maternal Mortality; D017063:Outcome Assessment, Health Care; D010342:Patient Acceptance of Health Care / Q000706:statistics & numerical data*; D011247:Pregnancy; D011295:Prenatal Care / Q000706:statistics & numerical data*; D018570:Risk Assessment; D012424:Rural Population; D012959:Socioeconomic Factors; D011795:Surveys and Questionnaires; D013636:Tanzania; D019472:Universal Health Insurance / Q000706:statistics & numerical data*; D055815:Young Adult
Africa; Maternal health services; Tanzania; delivery/obstetric; prenatal care; south of the Sahara; utilization