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

Late-stage disease at presentation to an HIV clinic in eastern Tanzania: A retrospective cross-sectional study

Background Late presentation and delayed treatment initiation is associated with poor outcomes in patients with HIV. Little is known about the stage at which HIV patients present at HIV clinics in Tanzania.Aim: This study aimed at determining the proportion of HIV patients presenting with WHO clinical stages 3 and 4 disease, and the level of immunity at the time of enrollment at the care and treatment center.Methods A retrospective cross-sectional study was conducted among 366 HIVinfected adults attending HIV clinic at Mwananyamala Hospital in Dar es Salaam, Tanzania. Data were obtained from the care and treatment clinic database.Results Late stage disease at the time of presentation was found in 276 (75.4%) of the patients; out of whom 153 (41.8%) presented with CD4 count <200 cells/ul and 229 (62.6%) presented with WHO clinical stage 3 or 4 at the time of clinic enrollment. Strategies to improve early diagnosis and treatment initiation should be improved

Factors influencing men’s involvement in antenatal care services: a cross-sectional study in a low resource setting, Central Tanzania

Abstract Background Men’s involvement can impact the delays in the decision to seek health care and in reaching a health facility, which are contributing causes for increased maternal mortality. Despite of the call to involve men in antenatal care, their participation is not well understood. This study aimed to determine the level of men’s involvement in antenatal care and the factors influencing their involvement in these services. Methods A cross sectional study of 966 randomly selected men aged 18 years or older was conducted in Dodoma Region, from June 2014 to November 2015. Face to face interviews were conducted using a pretested structured questionnaire. The outcome variable was men’s involvement and was constructed from four dichotomized items which were scored zero to two for low involvement and three to four for high involvement. A multiple logistic model was used to measure the factors influencing men’s involvement in antenatal care services. Results The level of men’s involvement in antenatal care was high (53.9%). Majority 89% of respondents made joint decisions on seeking antenatal care. More than half (63.4%) of respondents accompanied their partners to the antenatal clinic at least once. Less than a quarter (23.5%) of men was able to discuss issues related to pregnancy with their partner’s health care providers. About 77.3% of respondents provided physical support to their partners during the antenatal period. Factors influencing men’s involvement in antenatal care were occupation (AOR = 0.692, 95% CI = 0.511–0.936), ethnicity (AOR = 1.495, 95% CI = 1.066–2.097), religion (AOR = 1.826, 95% CI = 1.245–2.677), waiting time (AOR = 1.444, 95% CI = 1.094–1.906), information regarding men’s involvement in antenatal care (AOR = 3.077, 95% CI = 2.076–4.562) and men’s perception about theattitude of health care providers (AOR = 1.548, 95%CI = 1.090–2.199). Conclusion Overall, more than half of respondents reported high involvement in antenatal care services. Access to information on men’s involvement, religion, occupation, ethnicity, waiting time and men’s perception about the attitude of care providers were significant factors influencing men’s involvement in antenatal care services in this study. Health promotion is needed to empower men with essential information for meaningful involvement in antenatal care services

Health insurance is important in improving maternal health service utilization in Tanzania—analysis of the 2011/2012 Tanzania HIV/AIDS and malaria indicator survey

Abstract Background Maternal mortality rates vary significantly from region to region. Interventions such as early and planned antenatal care attendance and facility delivery with skilled health workers can potentially reduce maternal mortality rates. Several factors can be attributed to antenatal care attendance, or lack thereof, including the cost of health care services. The aim of this study was to examine the role of health insurance coverage in utilization of maternal health services in Tanzania. Methods Secondary data analysis was conducted on the nationally representative sample of men and women aged 15–49 years using the 2011/12 Tanzania HIV and Malaria Indicator Survey. It included 4513 women who had one or more live births within three years before the survey. The independent variable was health insurance coverage. Outcome variables included proper timing of the first antenatal care visit, completing the recommended number of antenatal care (ANC) visits, and giving birth under skilled worker. Data were analyzed both descriptively and using regression analyses to examine independent association of health insurance and maternal health services. Results Of 4513 women, only 281 (6.2%) had health insurance. Among all participants, only 16.9%, 7.1%, and 56.5%, respectively, made their first ANC visit as per recommendation, completed the recommended number of ANC visits, and had skilled birth assistance at delivery. A higher proportion of women with health insurance had a proper timing of 1st ANC attendance compared to their counterparts (27.0% vs. 16.0%, p < 0.001). Similar trend was for skilled birth attendance (77.6% vs. 55.1%, p < 0.001). After adjusting for other confounders and covariates, having health insurance was associated with proper timing of 1st ANC attendance (AOR = 1.89, p < 0.001) and skilled birth attendance (AOR = 2.01, p < 0.01). Conclusions Health insurance coverage and maternal health services were low in this nationally representative sample in Tanzania. Women covered by health insurance were more likely to have proper timing of the first antenatal visit and receive skilled birth assistance at delivery. To improve maternal health, health insurance alone is however not enough. It is important to improve other pillars of health system to attain and sustain better maternal health in Tanzania and areas with similar contexts