Spatial variation and inequities in antenatal care coverage in Kenya, Uganda and mainland Tanzania using model-based geostatistics: a socioeconomic and geographical accessibility lens

Pregnant women in sub-Saharan Africa (SSA) experience the highest levels of maternal mortality and stillbirths due to predominantly avoidable causes. Antenatal care (ANC) can prevent, detect, alleviate, or manage these causes. While eight ANC contacts are now recommended, coverage of the previous minimum of four visits (ANC4+) remains low and inequitable in SSA. We modelled ANC4+ coverage and likelihood of attaining district-level target coverage of 70% across three equity stratifiers (household wealth, maternal education, and travel time to the nearest health facility) based on data from malaria indicator surveys in Kenya (2020), Uganda (2018/19) and Tanzania (2017). Geostatistical models were fitted to predict ANC4+ coverage and compute exceedance probability for target coverage. The number of pregnant women without ANC4+ were computed. Prediction was at 3 km spatial resolution and aggregated at national and district -level for sub-national planning. About six in ten women reported ANC4+ visits, meaning that approximately 3 million women in the three countries had  20,000 women havin

Spatial variation and inequities in antenatal care coverage in Kenya, Uganda and mainland Tanzania using model-based geostatistics: a socioeconomic and geographical accessibility lens.

BACKGROUND: Pregnant women in sub-Saharan Africa (SSA) experience the highest levels of maternal mortality and stillbirths due to predominantly avoidable causes. Antenatal care (ANC) can prevent, detect, alleviate, or manage these causes. While eight ANC contacts are now recommended, coverage of the previous minimum of four visits (ANC4+) remains low and inequitable in SSA. METHODS: We modelled ANC4+ coverage and likelihood of attaining district-level target coverage of 70% across three equity stratifiers (household wealth, maternal education, and travel time to the nearest health facility) based on data from malaria indicator surveys in Kenya (2020), Uganda (2018/19) and Tanzania (2017). Geostatistical models were fitted to predict ANC4+ coverage and compute exceedance probability for target coverage. The number of pregnant women without ANC4+ were computed. Prediction was at 3 km spatial resolution and aggregated at national and district -level for sub-national planning. RESULTS: About six in ten women reported ANC4+ visits, meaning that approximately 3 million women in the three countries had  20,000 women having <ANC4+ visits were 38%, 1% and 1%, respectively. In many districts, ANC4+ coverage and likelihood of attaining the target coverage was lower among the poor, uneducated and those geographically marginalized from healthcare. CONCLUSIONS: These findings will be invaluable to policymakers for annual appropriations of resources as part of efforts to reduce maternal deaths and stillbirths

Assessment of midwifery care providers intrapartum care competencies, in four sub-Saharan countries: a mixed-method study protocol.

BACKGROUND: We aim to assess competencies (knowledge, skills and attitudes) of midwifery care providers as well as their experiences and perceptions of in-service training in the four study countries; Benin, Malawi, Tanzania and Uganda as part of the Action Leveraging Evidence to Reduce perinatal mortality and morbidity in sub-Saharan Africa project (ALERT). While today more women in low- and middle-income countries give birth in health care facilities, reductions in maternal and neonatal mortality have been less than expected. This paradox may be explained by the standard and quality of intrapartum care provision which depends on several factors such as health workforce capacity and the readiness of the health system as well as access to care. METHODS: Using an explanatory sequential mixed method design we will employ three methods (i) a survey will be conducted using self-administered questionnaires assessing knowledge, (ii) skills drills assessing basic intrapartum skills and attitudes, using an observation checklist and (iii) Focus Group Discussions (FGDs) to explore midwifery care providers' experiences and perceptions of in-service training. All midwifery care providers in the study facilities are eligible to participate in the study. For the skills drills a stratified sample of midwifery care providers will be selected in each hospital according to the number of providers and, professional titles and purposive sampling will be used for the FGDs. Descriptive summary statistics from the survey and skills drills will be presented by country. Conventional content analysis will be employed for data analysis of the FGDs. DISCUSSION: We envision comparative insight across hospitals and countries. The findings will be used to inform a targeted quality in-service training and quality improvement intervention related to provision of basic intrapartum care as part of the ALERT project. TRIAL REGISTRATION: PACTR202006793783148-June 17th, 2020

Are midwives ready to provide quality evidence-based care after pre-service training? Curricula assessment in four countries-Benin, Malawi, Tanzania, and Uganda.

This research sought to map midwifery pre-service training curricula as part of the Action Leveraging Evidence to Reduce perinatal morTality and morbidity in sub-Saharan Africa (ALERT) project conducted in Benin, Malawi, Tanzania, and Uganda. We conducted the review in two phases. In the first phase, online interviews were performed with the lead project midwives in all four study countries to get an overview of midwifery care providers' pre-service training courses, registration, and licensing requirements. We performed a mapping review of midwifery care providers' pre-service training curricula from different training institutions in the four study countries during the second phase. Curricula were reviewed and mapped against the International Confederation of Midwives (ICM) Essential Competencies framework to assess whether these curricula included the minimum essential training components described in the ICM framework. We identified 10 different professional titles for midwifery care providers. The number of years spent in pre-service training varied from one and a half to four years. Ten pre-service curricula were obtained and the assessment revealed that none of the curricula included all ICM competencies. Main gaps identified in all curricula related to women-centred care, inclusion of women in decision making, provision of care to women with unintended or mistimed pregnancy, fundamental human rights of individuals and evidence-based learning. This review suggests that there are skills, knowledge and behaviour gaps in pre-service training curricula for midwifery care providers when mapped to the ICM Essential Competencies framework. These gaps are similar among the different training courses in participating countries. The review also draws attention to the plethora of professional titles and different pre-service training curricula within countries. Trial registration: PACTR202006793783148-June 17th, 2020

Use of contraceptives and associated factors among male adolescents in rural secondary schools, Coast Region, Tanzania: a school-based cross-sectional study

Abstract Background Teenage pregnancy is still one of the reproductive health concerns facing adolescents in Tanzania. The problem has been associated with physiological, psychological, and social changes and increases the risk of unsafe abortion and adverse maternal, fetal, and neonatal outcomes among adolescents. Low utilization of contraceptive methods among adolescents is one of the key causes. The strategy of involving male adolescents in sexual and reproductive health programs can increase the rate of contraceptive use among adolescents, thereby preventing teenage pregnancy. Objective To examine factors associated with the uptake of contraceptives among male secondary school adolescent students. Methods This was a cross-sectional study conducted in rural secondary schools in Kisarawe District, Coast Region, Tanzania. Multi-stage sampling methods were used to recruit participants. Descriptive and multiple regression analyses were conducted to assess the prevalence and factors associated with contraceptive use. 95% confidence interval and p-value < 0.05 were considered statistical significance. Univariate and multivariate logistic regression were tested for the Crude Odds Ratio (COR) and Adjusted Odds Ratio (AOR) respectively. Results The study involved 422 male students with the majority of them 58.1% aged 17–19 years, 50.2% were Muslim, 76.3% were studying in government schools, 62.3% were from households size of 4–6 members, 87.4% were not in a relationship, and 64.2% were living with both parents. Less than half (38.9%) of male students reported ever having sex in their lifetime, and among them, very few (29.8%) used any method of contraceptive. The reported lowest age for the first sex was 10 years. The male condom was the most method used (69.4%) and Pharmacy/Chemist Shops were the common source of contraceptive services (55.1%). Students who had adequate knowledge of contraceptives were more likely to report the use of contraceptive methods compared to those who had inadequate knowledge (AOR = 2.704, 95% CI: 1.220–5.995, p = 0.014). Participants in Private schools were 4.3 times more likely to report the use of contraceptives than those in government schools (AOR = 4.347, 95% CI: 1.758–10.762, p = 0.01). Students in a relationship were 3.5 times more likely than those not in a relationship to report the use of a contraceptive method (AOR = 3.51, 95% CI: 1.421–8.670, p = 0.006). Conclusion The study found the low use of contraceptives among male adolescents who ever had sex in their lifetime. Thus, it’s suggested that age-tailored comprehensive sexual and reproductive health education should start to be taught from a very young age as adolescents initiate sex at an early age. Also, Teenage pregnancy prevention programs should involve males as the key players during the development and implementation of the program as most of the decisions among partners are from men

Development and pilot test of a smartphone app for midwifery care in Tanzania: A comparative cross-sectional study.

To address Tanzania's high maternal mortality ratio, it is crucial to increase women's access to healthcare. To improve access, the quality of antenatal care needs to be improved. Therefore, we conducted a pilot study of a smartphone app for midwives and examined its potential effects on the learning outcomes of midwives and birth preparedness of pregnant women in Tanzania. This mixed-methods, pilot study provided an educational app for midwives in the intervention group, obtained data about the continuous use of the app, measured midwives' learning outcomes, directed focus group discussions on the usability of the app, and conducted surveys among pregnant women about birth preparedness in the intervention and control groups to evaluate if midwives provided proper information to them. The control group received regular antenatal care and answered the same survey. Participants were 23 midwives who participated in the testing and provided learning outcome data. Twenty-one participated in focus group discussions. Results showed that 87.5% of midwives continued to study with the app two months post-intervention. A mini-quiz conducted after using the app showed a significant increase in mean scores (6.9 and 8.4 points, respectively) and a non-significant increase on the questionnaire on women-centered care (98.6 and 102.2 points, respectively). In the focus group discussions, all midwives expressed satisfaction with the app for several reasons, including comprehensive content, feelings of confidence, and reciprocal communication. There were 207 pregnant women included in the analysis. The intervention group had significantly higher knowledge scores and home-based value scores than did controls. The total scores and other subscales did not show statistical significance for group differences. The results indicate the potential impact of the midwifery education app when it is implemented on a larger scale, especially considering that the results show a potential effect on midwives' learning outcomes

Knowledge of danger signs during pregnancy and subsequent healthcare seeking actions among women in Urban Tanzania: a cross-sectional study

Abstract Background Tanzania is among the countries with a high maternal mortality ratio. However, it remains unclear how information and education on danger signs of pregnancy translate into appropriate actions when a woman recognizes danger signs. This study aimed to determine women’s knowledge of obstetric danger signs during pregnancy and their subsequent healthcare seeking actions. Methods The study design was a health facility-based cross-sectional study. Quantitative data were collected through interviewer-administered questionnaires. Descriptive and inferential statistics were used to analyze the data. The study enrolled 384 women from two health centers in Kinondoni Municipality, Dar es Salaam, Tanzania. A woman who had not mentioned any danger sign was categorized as having no knowledge, mentioned one to three danger signs as having low knowledge, and mentioned four or more danger signs as having sufficient knowledge. Results Among the 384 participants, 67 (17.4%) had experienced danger signs during their pregnancy and reported their healthcare seeking actions after recognizing the danger signs. Among those who recognized danger signs, 61 (91%) visited a healthcare facility. Among the 384 participants, five (1.3%) had no education, 175 (45.6%) had primary education, 172 (44.8%) had secondary education, and 32 (8.3%) had post-secondary education as their highest educational levels. When asked to spontaneously mention the danger signs, more than half of the participants (n = 222, 57.8%) were able to mention only one to three danger signs. Only 104 (31%) had correct knowledge of at least four danger signs and nine (2.7%) were not able to mention any item. The most commonly known pregnancy danger signs were vaginal bleeding (81%); swelling of the fingers, face, and legs (46%); and severe headache (44%). Older women were 1.6 times more likely to have knowledge of danger signs than young women (OR 1.61; 95% CI 1.05-2.46)”. Conclusion Women took appropriate healthcare seeking action after recognizing danger signs during pregnancy. However, the majority had low knowledge of pregnancy danger signs. Additional studies are warranted to address the knowledge gap and to plan interventions for improving health education under limited resource settings

A feasibility study of an educational program on obstetric danger signs among pregnant adolescents in Tanzania: A mixed-methods study

Background: In Tanzania, adolescents have a high lifetime risk of dying from pregnancy and childbirth complications. Objective: To determine the feasibility of an education program in improving knowledge of obstetric danger signs and promoting appropriate healthcare-seeking behavior, as well as encouraging the development of a peer network support group. Methods: An embedded mixed-methods design was used. This research was a pilot study conducted in a health facility in rural Tanzania. Quantitative data was collected before and after the education program using questionnaires. Focus group discussion was used to collect qualitative data. Results: 15 pregnant adolescents between 15 and 19 years of age participated. Their median age was 18.0 years (SD ± 1.19), and 66.7% were ≤18 years. There was a significant increase in the scores of knowledge of danger signs during pregnancy between the pre-test (M = 7.20, SD = 2.83) and the post-test (M = 9.07, SD = 1.67); t = 2.168, p = 0.048. There was a significant strong positive correlation between the healthcare-seeking behavior score and social support score variables [r = 0.654, p = 0.008]. The education program was feasible in terms of implementation, acceptability, and demand as indicated by its >84% score. Four categories were identified from the qualitative data: “supportive family”, “rejection and abortion”, “support from peers”, and “potential barriers to seek care”. Conclusion: The development of an education program particularly on obstetric danger signs was feasible and helpful for pregnant adolescents in Tanzania. Keywords: Pregnancy, Adolescent, Obstetric danger signs, Social support, Healthcare-seeking behavior, Antenatal car

The comparison of BPQ scores between the intervention and control groups in unadjusted and adjusted ANCOVA.

The comparison of BPQ scores between the intervention and control groups in unadjusted and adjusted ANCOVA.</p