Using the Theory of Planned Behaviour to Describe Male Involvement Intention During Childbirth Among Expecting Couples in a Rural Setting: A Cross-Sectional Study From Rukwa Region, Southern Tanzania

Background: Male involvement during childbirth can increase utilisation of maternal services and reduce maternal and neonatal mortality. An individual’s intention towards such male involvement can be understood through the theory of planned behaviour, which postulates that such intention is influenced by 3 domains: 1) attitudes, 2) perceptions of social approval (subjective norms) and 3) feelings about control over the intended behaviour. In sub-Saharan Africa, rates of male involvement in childbirth birth are low, and little is known about the predictors of intention for such involvement among expecting couples in rural Africa. This study aimed to determine the influence of the 3 domains of intention on male involvement intention during childbirth among expecting couples in Rukwa Region, Tanzania.   Methods: We conducted a community-based, cross-sectional study of pregnant women and their partners from June until October 2017. In total, 546 couples (n=1,092 participants) were identified through 3-stage probability sampling. A structured questionnaire based on the theory of planned behaviour was used to elicit information on the 3 domains of intention.   Results: Most pregnant women (71.6%) and their male partners (77.3%) intended to have male involvement during childbirth. Among women, only positive attitude (odds ratio [OR] 0.2, 95% CI, 0.1 to 0.7; P=.012) was significantly associated with intention, though in an unexpected direction. In adjusted analysis, men’s positive attitude (adjusted odds ratio [AOR] 9.0, 95% CI,1.9 to 40.9; P=.004) and positive subjective norms (AOR 4.4, 95% CI, 1.1 to 18.6; P=.041) were significantly associated with an increased likelihood of intention to accompany their partners during childbirth.   Conclusion: More male partners had the intention to accompany their spouses during childbirth compared to their female partners. Male attitudes and subjective norms may be influential in determining male involvement during childbirth in rural African settings

Prevalence and Predictor of Exclusive Breastfeeding among Mothers of 0 to 6 months Infants from Pastoralists and Hunters’ Community in Tanzania; A Community Based Cross-Sectional Study

Background: Initiating breastfeeding during the first hour after birth and continuing breastfeeding exclusively for 6 months prevents childhood infections such as diarrhoea. Exclusive breastfeeding (EBF) for the first 6 months of life of the baby is recognised globally as the best and the most effective intervention to ensure the survival of babies. The aim of this study was to determine the prevalence of EBF and its predictors among mothers of 0 to 6 months infants from pastoralists and hunters’ community in Manyara region-Tanzania. Methods: This was a community-based analytical cross-sectional study that involved 342 mothers of 0 to 6 months infants who were randomly selected through 4 stage multistage sampling technique. Data was collected using an intervieweradministered questionnaire. Collected data was analysed using Statistical Package for Social Sciences (SPSS) version 20. Binary Logistic Regression analysis was used to establish factors associated with EBF practices. Results: The prevalence of EBF among postnatal women from hunters and pastoralists societies was 47.1% at 95% CI=41.7%-52.5%. After adjusted for confounders, the predictors of EBF practice were age of infants (0-1 months, AOR= 2.838 at 95% CI = 1.326-6.075, p=.007), age of mothers (26-35 years, AOR=1.851 at 95% CI= 1.059-3.234, p=.031), Level of education of infants’ mothers (primary education, AOR= 2.374 at 95% CI= 1.321-4.265, p=.004) and knowledge on exclusive breast feeding, AOR=2.51 at 95% CI= 1.435-4.393, p=.001. Conclusion: Majority of mothers from pastoralists’ and hunters’ societies were not practising EBF. Predictors of EBF practice were; the age of infants, maternal age, level of education of the mother and knowledge on exclusive breastfeeding. Poor EBF practice was mainly contributed to low level of knowledge about the EBF. The low level of knowledge could have been contributed by poor access to maternal services. Nature of living (lack of permanent settlement) of the study population could have contributed to low access to maternal  services. An innovative interventional study is highly recommended to come up with strategies that will improve knowledge on EBF and practice of EB

Prevalence and Factors Associated with Home Childbirth with Unskilled Birth Assistance in Dodoma -Tanzania: A Cross Sectional Study

Background: Improving maternal health is one of the goals to be achieved under the Sustainable Development Goal (SDG) number 3. Worldwide, half a million of women die each year from pregnancy and childbirth related complications which can be prevented by skilled birth assistance. One of the determinants of maternal health is place of childbirth. Giving birth at home leads to a high risk of maternal and child mortality. The aim of the study was to determine the prevalence and factors associated with choice of home childbirth in Dodoma Municipality.Methods: A community based cross section study using multistage sampling was used to obtain the sample in which 2,523 women who gave birth within 3 years prior to the date of the study from different wards of Dodoma municipal were interviewed. The data obtained were entered and analysed using SPSS version 20. Binary logistic regression analysis was used to establish predictors of home childbirth with unskilled birth assistance.Results: A total of 1,174 (46.5%) women had home childbirth with unskilled birth assistance. After adjusted for the confounders, predictors of home childbirth with unskilled birth assistance among study respondents were level of education [primary education, AOR=0.69 at 95% CI=0.557-0.854,p<.001; secondary education, AOR=0.492 at 95% CI=0.358-0.676,p<.001 and above secondary education, AOR=0.35 at 95% CI=0.16-0.765;p<.01]; marital status [married women, AOR=0.686 at 95% CI=0.547-0.86, p<.001]; occupation of a mother [peasant, AOR=1.508 at 95% CI=1.214-1.874, p<.05]; parity [2 to 4 children, AOR=1.316 at 95% CI=1.028-1.684,p<.05; More than 4 children, AOR=2.006 at 95% CI=1.427-2.82,p<.001]; number of antenatal visits [4 or more antenatal visits, AOR=0.451 at 95% CI=0.204-0.997,p<.05] and walking distance [less than 5kilometres, AOR= 0.797 at 95% CI=0.674-0.943,p<.001]Conclusion: The findings of this study suggest a need for health education in the community on the importance of skilled birth delivery. There is also a need for the government to roll out the implementation of Primary Health Services Development Program (PHSDP-MMAM) which addresses the delivery of health services within 5 kilometres to ensure fair, equitable and quality health services to the community

Predictors of condom use among unmarried sexually active women of Reproductive age in Tanzania

Background: Condom is one of the methods for prevention against Human Immunodeficiency Virus and other Sexually Transmitted Infections. It is also considered an effective method for preventing unwanted pregnancies. Despite the several interventions that have been put to promote condom use, still a large proportion of women do not use condom during sexual intercourse. Objectives: This study aimed at determining predictors of condom use among unmarried sexually active women of reproductive age in Tanzania. Methods: This study used secondary data from the 2015-16 Tanzania Demographic and Health Survey and Malaria Indicator Survey (2015-16 TDHS-MIS). It involved unmarried sexually active women aged 15-49 years. Multiple binary logistic regression was used to determine predictors for condom use at last sexual intercourse. Results: Overall, lower proportion (31.1%) of unmarried sexually active women used condom at last sexual intercourse. The odds of using condom during last sexual intercourse was lower aOR=0.67 and aOR=0.65 for women aged 20-24 and 25+ years respectively). Women who reported higher age (18+ years) at first sex had higher odds (aOR=1.65) of using condom compared to those started sex before 15 years old. Women owning telephone had higher odds (aOR=1.44) compared to women without telephone. Also, higher odds of using condom were observed for women in the Southern, South West highlands, and Eastern zones compared to the Central zone. Discussion: Age, marital union, parity, wealth, ownership of; mobile phone, television, access to newspapers, and radio significantly predicts condom use among unmarried sexually active women of reproductive age in Tanzania. Conclusion: The level of condom use among unmarried women in Tanzania is very low and varies by age, age at sex intercourse, ownership of phone and zones. Targeted interventions are needed to promote the condom use among unmarried women in order to mitigate the risk of HIV and un-intended pregnancies

Understanding the preference for homebirth; an exploration of key barriers to facility delivery in rural Tanzania

Abstract Background There is limited information on the effect of expectant parents’ socio-cultural perceptions and practices on the use of skilled birth attendants (SBAs) in rural Tanzania. The purpose of this study was to explore the socio-cultural barriers to health facility birth and SBA among parents choosing home birth in rural Tanzania, specifically in the Rukwa Region. Methods This study used a descriptive exploratory methodology. Purposive sampling was used to recruit study participants for both in-depth interviews (IDIs) and focused group discussions (FGDs). Qualitative research methods, including FGDs and IDIs, were utilized in data collection. The respondents were men and women whose youngest child had been born at home within the prior 12 months. A thematic approach was used for data analysis. Results The main themes that emerged regarding barriers to the use of health facility were 1) limited decision-making by men on place of delivery; 2) low risk perception by men and its interference with health facility birth; 3) men’s limited resource mobilization for health facility birth and 4) females’ perceptions that pregnancy and childbirth are low-risk events. Conclusion This qualitative study demonstrates that apart from well-documented structural barriers to skilled birth attendance in rural Tanzania, the low risk perception among both men and women plays a substantial role. The low risk perception among both men and women affects the use of SBAs in two ways. First, women become negligent and take risk of delivering at home. Second, male partners do not seriously mobilize resources for health facility childbirth. These findings reinforce the urgent need to implement creative programs to increase genuine male participation in facilitation of health facility childbirth

Assessing motivators for utilizing family planning services among youth students in higher learning institutions in Dodoma, Tanzania: Protocol for analytical cross sectional study.

IntroductionContraceptive services utilization is an important intervention in averting the impact of unwanted and unplanned pregnancy among youth which is an obstacle to the higher learning institutions youth students in attaining their educational goals. Therefore, the current protocol aims to assess the motivators for family planning service utilization among youth student in higher learning institutions in Dodoma Tanzania.MethodsThis study will be a cross-sectional study with quantitative approach. A multistage sampling technique will be employed in studying 421 youth students aged between 18 to 24 years using structured self-administered questionnaire adopted from the previous studies. The study outcome will be family planning service utilization and independent variables will be family planning service utilization environment, knowledge factors, and perception factors. Other factors such as socio-demographic characteristics will be assessed if they are confounding factors. A factor will be considered as a confounder if it associates with both the dependent and the independent variables. Multivariable Binary logistic regression will be employed in determining the motivators for family planning utilization. The results will be presented using percentages, frequencies, and Odds Ratios and the association will be considered statistically significant at p-value <0.05

The magnitude of teenage pregnancy and its associated factors among teenagers in Dodoma Tanzania: a community-based analytical cross-sectional study

Plain English summary The study is reporting the status of teenage pregnancy among adolescents aged 15–19 years in the Dodoma Region. Dodoma Region is the capital city of Tanzania and it is among the fastest-growing city of Tanzania. The region has the highest population of youth in Tanzania. In addition, the study is reporting on factors associated with teenage pregnancy. A range of factors that have been reported by previous studies was assessed in this study to test whether they are significant factors in this population. These factors were sociodemographic factors (age, sex, marital status, education, occupation), social factors (Peer pressure, sexual abuse), familial factors (Household socio-economic status, domestic violence, marital status,), behavioral factors (like age at first sexual intercourse, early marriage, and contraceptive use, perception on teenage pregnancy, family income, peer pressure, and casual sex) and knowledge on sexual and reproductive health. The findings from this study are key to the development of a focused intervention study that will work out the strategies to be used to solve the problem of teenage pregnancies in Dodoma Region Tanzania

The Effectiveness of Community-Based Continuous Training on Promoting Positive Behaviors towards Birth Preparedness, Male Involvement, and Maternal Services Utilization among Expecting Couples in Rukwa, Tanzania: A Theory of Planned Behavior Quasi-Experimental Study

Background. Rukwa Region has the highest maternal mortality ratio, 860 deaths per 100,000 live births in Tanzania. The region has neonatal mortality rate of 38 deaths per 1,000 live births. Previous interventions to promote maternal and neonatal health targeted access to maternal services by removing financial barriers and increasing the number of health facilities. However, maternal service utilization remains very low, especially facility delivery. The proposed intervention was sought to address deep-rooted behavioral beliefs, normative beliefs, control beliefs, and knowledge empowerment to determine their effect on improving birth preparedness, male involvement, and maternal services utilization. The study tested the effectiveness of a Community-Based Continuous Training (CBCT) intervention that was based upon the theory of planned behavior and was sought to promote positive behaviors. Methods. The study used a quasi-experimental design. The design consisted of pre- and postintervention assessments of two nonequivalent groups. Two districts were selected conveniently using criteria of high home birth. A district to hold intervention was picked randomly. Study participants were expecting couples at gestation age of 24 weeks and below. After obtaining informed consents, participants were subjected to baseline assessment. Expecting couples in the intervention group had two training sessions and two encounter discussions. The three primary outcomes of the study were changes in the level of knowledge about birth preparedness, male involvement, and use of maternal services. Data were collected at preintervention, midintervention, and postintervention. Policy Implications of the Results. The aim of this paper was to describe the study protocol of a quasi-experimental study design to test the effectiveness of an interventional program on promoting positive behaviors on birth preparedness, male involvement, and maternal services utilization among expecting couples. This study has a potential to address the challenge of low birth preparedness, male involvement, and use of maternal health services in Rukwa Region

Cervical Cancer Awareness among Women in Tanzania: An Analysis of Data from the 2011-12 Tanzania HIV and Malaria Indicators Survey

Background. Awareness about cervical cancer is a first step in the process of screening and early treatment. The purpose of this study was to provide better understanding of basic knowledge about cervical cancer among women of reproductive age in Tanzania. Method. Data were analyzed from the 2011-2012 Tanzania HIV and Malaria Indicators Survey (THMIS) and a sample of 5542 sexually active women from 15 to 49 years of age were included in the analysis. Results. Overall knowledge about cervical cancer was high among interviewed women. Only 30.9% of women had never heard about cervical cancer. The predictors of awareness were having secondary or more level of education (AOR = 3.257, 95% CI 2.328–4.557, p<0.001), residing in urban (AOR = 1.365, 95% CI 1.093–1.705, p<0.01), being affluent (AOR = 2.685, 95% CI 2.009–3.587, p<0.001), having one to four children (AOR = 1.36, 95% CI 1.032–1.793), and age of 30–34 years (AOR = 3.15, 95% CI 2.353–4.220, p<0.001), 35–39 years (AOR = 2.46, 95% CI 1.831–3.308, p<0.001), and 40–44 years (AOR = 3.46, 95% CI 2.497–4.784, p<0.001). Conclusion. While the cervical cancer landscape in Tanzania has evolved since this survey, coverage has not yet been achieved and access to cervical cancer prevention services for rural women and girls remains a concern. Women who were least likely to be aware of cervical cancer were rural women, less affluent women, those with limited education, and those with limited access to the formal economy. Arguably, these are the women who are most at risk for cervical cancer. To close this gap, Tanzania’s ongoing efforts to increase access to high-quality cervical cancer prevention services for all women at risk are commendable

Using the Theory of Planned Behavior to Explain Expecting Couples Birth Preparedness Intentions in a Rural Setting: A Cross-Sectional Study from Rukwa, Southern Tanzania

Background. According to the Theory of Planned Behavior, an intention to carry out a certain behavior facilitates action. In the context of planning for birth, certain preparations and planning may better ensure maternal and neonatal survival. Little is known on the predictors of birth preparedness intention among expecting couples. The aim of this study was to determine the predictors of birth preparedness intentions among expecting couples. Methods. A community based cross-sectional study targeting pregnant women and their partners was performed from June until October 2017. A three-stage probability sampling technique was employed to obtain a sample of 546 couples A structured questionnaire based upon the Theory of Planned Behavior was used. The questionnaire explored three main domains of birth preparedness intentions. These three domains included (1) attitudes towards birth preparedness, (2) perceived subjective norms towards birth preparedness, and (3) perceived behavior control towards birth preparedness. Results. The vast majority of study participants had birth preparedness intentions. This included 521 (95.4%) pregnant women and 543 (99.5%) of their male partners. After adjusting for the confounders, the predictors of birth preparedness intentions among pregnant women were attitude (AOR=70.134, 95% CI=12.536-392.360, p<0.001) and perceived behavior control (AOR=7.327, 95% CI=1.545-34.761, p<0.05) which were significant. Among male partners, only attitudes (AOR=31.315, 95% CI=1.497-655.149, p<0.05) influenced the birth preparedness intention. Conclusion. Birth preparedness intention among male partners was higher compared to their female partners. The reason for the difference could be the concern each group puts on the issue of birth preparedness. Among the three domains of intention, attitude and perceived behavior control were statistically significant predictors of birth preparedness intention among pregnant women. Attitude was the only domain which influenced birth preparedness intention among male partners. Therefore, interventional studies are recommended targeting attitudes and perceived behavior control in order to boost birth preparedness intention