Factors Associated with First Antenatal Care Booking among Pregnant Women at a Reproductive Health Clinic in Tanzania: A Cross Sectional Study

Background: Antenatal care (ANC) is a key basic intervention targeting maternal and perinatal morbidity and mortality. The World Health Organization (WHO) recommends the first ANC booking before 12 weeks of gestation. This enhances positive maternal and fetal outcomes through early detection of complications, prompt treatment, referral, and management of expected physiological changes. Despite high ANC coverage (98%), free contacts, and easy accessibility, little is known why few (24%) pregnant women in Tanzania book their first ANC-visit early. This study aimed to identify factors associated with first ANC booking among pregnant women in a Tanzanian reproductive health clinic. Methods: Systematic random sampling was used to recruit 311 eligible pregnant women. Study data were collected using a structured interviewer-administered questionnaire containing 22 closed ended questions. Data were analyzed using descriptive statistics. Frequency distribution tables and figures were generated. Multivariate analysis was used to assess the influence of the independent variables on the dependent variable. A p-value \u3c 0.05 was considered statistically significant. Results: In total, 311 pregnant women were interviewed; 31.2% (n = 97) booked their first ANC-visit within 12 weeks of gestation and 68.8% (n = 214) after 12 weeks of gestation. Early ANC booking was associated with tertiary education, planned pregnancy, earlier pregnancy recognition, and experience or presence of any complications. Commonly reported barriers to early ANC booking included not knowing the recommended time to initiate booking (37.6%), waiting for the fetus to move (28.6%), and previous experience of waiting a long time (15.8%). Conclusion: Most pregnant women booked their first ANC visit later than WHO and national recommendations. Women thus miss accurate early pregnancy assessment for better positive pregnancy outcomes

TBA Knowledge performance and Relation with the Formal Health System in Lindi Region and the role of Maternal Waiting Homes

In Lindi region 110 active trained TBAs (10 or more deliveries per year) and women who delivered with TBAs were interviewed about the role of these TBAs, their knowledge and practice and their relationship with the health facilities. In addition key information in the communities, the districts and the health care system were interviewed. The study that play a unique role in their respective communities as care giver for delivering mother and as principal advisor to families in all issues related to birth –giving. They are highly appreciated by their clients and the communities and often preferred to the health facilities, which are perceived as too expensive, hardly accessible and staff often not friendly to the clients. The training has increased the reputation of the TBAs in the community because they are perceived as comparable to the staff in the facility where they went for training. TBAs complained that I cases where the local government financed the training clients afterwards expect to get the service free of change because it was the community who paid for training. In addition communities are suspicious that the trained TBA gets money from the government. The TBAs do not play the expected role in referral because referral to the health facilities is perceived as a professional failure on the side of the TBA and as a shame on the part of the woman. The communication between health services and the TBAs is not satisfactory. There is no supervision and monitoring, no visits to the TBAs or any kind of meeting and supply of gloves or other equipment. Proper records are not available especially regarding problems during delivery (death of mother or the child). It is recommended that working relation between formal health system and TBAs has to be improved. Maternal waiting homes are not yet available in Lindi Region however a need is perceived by professionals and communities because many villages are too far from the nearest health facilities to make use of it for delivery. One church hospital offers a simple house for woman and their relatives where they can stay while waiting. However it does not yet meet the criteria defined by the Maternal Waiting Homes

Customs and practices during pregnancy, childbirth, and the postpartum period in the Kilimanjaro area, Tanzania

Introduction: Here, we report the traditions, customs, and beliefs of rural women during pregnancy, childbirth, and the postpartum period in rural Tanzania, and discuss how they compromise between traditional and modern perceptions of maternity care and experiences. Methods: A focus group interview with nine women who have children under 5 years old was conducted by a midwife researcher（ one of the authors） in Rombo, a village in the Kilimanjaro region, in Tanzania, in December 2009. The interview was translated from the local language into English and transcribed. The data were assessed by describing and categorizing as pregnancy, childbirth, after childbirth, and feeding of the baby.Results: The women recognized the importance of institutional delivery, but also appreciated cultural practices related to childbirth. Goats, bananas, local beer made from bananas, and kanga（ Tanzanian pareu or wraparound skirt） were important items not only for pregnancy and childbirth, but also for daily life in the study area. They integrated medical approaches by health professionals and traditional approaches by the family in childbirth.Conclusions: A transition gap regarding the modern and traditional practices was not clearly observed as in urban areas in the present study area, but it is possible that the same conditions will arise in this area in future. It is necessary to take traditional customs and practices into consideration to improve women’s satisfaction regarding childbirth and delivery

HIV and infant feeding counselling: challenges faced by nurse-counsellors in northern Tanzania

<p>Abstract</p> <p>Background</p> <p>Infant feeding is a subject of worry in prevention of mother to child transmission (pMTCT) programmes in settings where breastfeeding is normative. Nurse-counsellors, expected to counsel HIV-positive women on safer infant feeding methods as defined in national/international guidelines, are faced with a number of challenges. This study aims to explore the experiences and situated concerns of nurses working as infant feeding counsellors to HIV-positive mothers enrolled in pMTCT programmes in the Kilimanjaro region, northern Tanzania.</p> <p>Methods</p> <p>A qualitative study was conducted using in-depth interviews and focus group discussions (FGDs) with 25 nurse-counsellors at four pMTCT sites. Interviews were handwritten and FGDs were tape-recorded and transcribed, and the programme Open Code assisted in sorting and structuring the data. Analysis was performed using 'content analysis.'</p> <p>Results</p> <p>The findings revealed a high level of stress and frustration among the nurse-counsellors. They found themselves unable to give qualified and relevant advice to HIV-positive women on how best to feed their infants. They were confused regarding the appropriateness of the feeding options they were expected to advise HIV-positive women to employ, and perceived both exclusive breastfeeding and exclusive replacement feeding as culturally and socially unsuitable. However, most counsellors believed that formula feeding was the right way for an HIV-positive woman to feed her infant. They expressed a lack of confidence in their own knowledge of HIV and infant feeding, as well as in their own skills in assessing a woman's possibilities of adhering to a particular method of feeding. Moreover, the nurses were in general not comfortable in their newly gained role as counsellors and felt that it undermined the authority and trust traditionally vested in nursing as a knowledgeable and caring profession.</p> <p>Conclusion</p> <p>The findings illuminate the immense burden placed on nurses in their role as infant feeding counsellors in pMTCT programmes and the urgent need to provide the training and support structure necessary to promote professional confidence and skills. The organisation of counselling services must to a larger extent take into account the local realities in which nurses construct their role as counsellors to HIV-positive childbearing women.</p

The Potential Role of Mother-in-Law in Prevention of Mother-to-Child Transmission of HIV: A Mixed Methods Study from the Kilimanjaro Region, Northern Tanzania.

In the Kilimanjaro region the mother-in-law has traditionally had an important role in matters related to reproduction and childcare. The aim of this study was to explore the role of the mothers-in-law in prevention of mother-to-child transmission (PMTCT) service utilization and adherence to infant feeding guidelines. The study was conducted during 2007-2008 in rural and urban areas of Moshi district in the Kilimanjaro region of Tanzania. Mixed methods were used and included focus group discussions with mothers-in-law, mothers and fathers; in-depth interviews with mothers-in-law, mothers, fathers and HIV-infected mothers, and a survey of 446 mothers bringing their four-week-old infants for immunisation at five reproductive and child health clinics. The study demonstrated that the mother-in-law saw herself as responsible for family health issues in general and child care in particular. However she received limited trust, and couples, in particular couples living in urban areas, tended to exclude her from decisions related to childbearing and infant feeding. Mothers-in-law expected their daughters-in-law to breastfeed in a customary manner and were generally negative towards the infant feeding methods recommended for HIV-infected mothers; exclusive replacement feeding and exclusive breastfeeding. Decreasing influence of the mother-in-law and increasing prominence of the conjugal couples in issues related to reproduction and child care, reinforce the importance of continued efforts to include male partners in the PMTCT programme. The potential for involving mothers-in-law in the infant feeding component, where she still has influence in some areas, should be further explored

Present conditions of evidence-based practices among nursing and midwifery professionals in Tanzania

Objectives: This study was performed to evaluate nurses’ knowledge, attitudes, and practices regarding evidence-based practice（ EBP） in Tanzania. Methods: A self-administered questionnaire survey regarding EBP was conducted among nurses working in Muhimbili University Hospital, which is a teaching hospital, and three other non-teaching hospitals from October to December 2016. The questionnaire consisted of 10 measures regarding EBP in addition to demographic characteristics and EBP training experience. Results: A total of 143 nurses participated in the questionnaire survey regarding EBP, and 131 completed questionnaires without missing data were included in the analysis. Nurses working inMuhimbili University Hospital were more likely to receive EBP training than those working in the other institutions （chi-square test, P = 0.015）. Recognition of the importance of receiving EBP （P = 0.019）, frequency of using print information resources（ P = 0.009）, and frequency of using electronic resources （P = 0.001） were significantly higher among nurses with EBP training. Nurses with EBP training experience reported the use of greater numbers of research articles as well as printed and electronic resources for EBP. EBP training for nurses may improve the capacity for research using appropriateresources and access for EBP. Conclusion: EBP training programs should be targeted toward nurses with a diploma, those not workingin Muhimbili University Hospital, and those without EBP training. The concerns of nurse managers and/or supervisors should also be addressed to achieve EBP among staff nurses in clinical settings

Perceptional gaps among women, husbands and family members about intentions for birthplace: a cross-sectional study

Objetivo: as mulheres são mais propensas a dar à luz em um centro de saúde quando suas famílias estão de acordo com o local de nascimento. No entanto, nas áreas rurais da Tanzânia, as mulheres são muitas vezes marginalizadas do processo de decisão. Este estudo fez previsoes de intenção para o local do parto e fatores para reduzir as lacunas de percepção entre as mulheres grávidas, seus maridos e familiares identificados. Método: estudo transversal explicativo realizado em três aldeias no nordeste da Tanzânia. Os participantes foram 138 mulheres grávidas e suas famílias que responderam ao Questionário de Intenção sobre Parto (BIQ), medindo o conhecimento, atitude, percepcão de controle comportamental, normas subjetivas e intenção para lugar de parto. Análise descritivas, ANOVA, Qui-quadrado e regressão linear múltipla foram utilizados para analisar os dados. Resultados: o modelo de regressão mostrou que o conhecimento, percepcão de controle comportamental e normas subjetivas previram intenção de lugar de parto (R2 = 0,28). Enquanto 81% das mulheres grávidas pensavam que seus maridos eram os decisores para seu parto, apenas 38% dos maridos e 37% dos membros da família concordaram. As mulheres grávidas tiveram escores significativamente mais baixos sobre o item “Vou me preparar para o parto com a minha família”, em comparação com os maridos (p < 0,01) e outros membros da família (p < 0,001). Conclusão: Proporcionar preparação para o parto baseada em evidencias e a redução das lacunas de percepção identificadas podem melhorar a intenção das mulheres para dar à luz em unidades de saúde.Objective: women are more likely to give birth at a health facility when their families agree with the birthplace. However, in rural areas of Tanzania, women are often marginalized from decision-making. This study predicted birthplace intention and identified factors to reduce perceptional gaps among pregnant women, husbands and family members. Method: explanatory cross-sectional survey was conducted in three villages in North Eastern Tanzania. Participants were 138 pregnant women and their families who answered the Birth Intention Questionnaire (BIQ), measuring knowledge, attitude, perceived behavioral control, subjective norms and intention for birthplace. Descriptive analysis, ANOVA, Chi-square, and multiple linear regression was used to analyze the data. Results: the regression model showed that knowledge, perceived behavioral control, and subjective norms predicted intention for birthplace (R2 = .28). While 81% of pregnant women thought their husbands were decision-makers for their birth, only 38% of husbands and 37% of family members agreed. Pregnant women had significantly lower scores on the item “I will prepare for childbirth with my family” compared with husbands (p < .01) and other family members (p < .001). Conclusion: providing evidence-based birth preparation and reducing the identified perceptual gaps may enhance women’s intention to deliver at health facilities.Objetivo: las mujeres son más propensas a dar a luz en un centro de salud cuando sus familias están de acuerdo con el lugar de parto. Sin embargo, en las zonas rurales de Tanzania, las mujeres son a menudo marginadas de la toma de decisiones. Este estudio predijo la intención del lugar de parto y los factores identificados para reducir la brecha de percepción entre las mujeres embarazadas, esposos y miembros de la familia. Método: encuesta transversal explicativa llevada a cabo en tres aldeas en el noreste de Tanzania. Los participantes fueron 138 mujeres embarazadas y sus familias, que respondieron al Cuestionario sobre Intención del Parto (BIQ), que mide el conocimiento, la actitud, percepción de control del comportamiento, las normas subjetivas y la intención de lugar de parto. Se utilizaron análisis descriptivo, ANOVA, Chi-cuadrado y regresión lineal múltiple para analizar los datos. Resultados: el modelo de regresión mostró que el conocimiento, la percepción de control del comportamiento, y las normas subjetivas predijeron la intencion del lugar de parto (R2 = 0,28). Mientras que el 81% de las mujeres embarazadas pensaba que sus maridos estaban encargados de tomar decisiones para el nacimiento, sólo el 38% de los esposos y el 37% de los miembros de la familia estuvieron de acuerdo. Las mujeres embarazadas tenían puntuaciones significativamente más bajas en el tema “Me prepararé para el parto con mi familia”, en comparación con los maridos (p < 0,01) y otros miembros de la familia (p < 0,001). Conclusión: proporcionar la preparación al parto basada en la evidencia y reducir las brechas de percepción identificadas pueden mejorar intención de las mujeres a dar a luz en centros de salud

Predictors of fear of childbirth and depressive symptoms among pregnant women: a cross-sectional survey in Pwani region, Tanzania

Background: Many women experience fear of childbirth (FoB) and depressive symptoms (DS) during pregnancy, but little is known about FoB among Tanzanian women. The current study aimed to assess the prevalence of FoB and DS among pregnant women and determine predictors of each and both, focusing on sociodemographic and obstetric predictors. Methods: A cross-sectional study was conducted at six health facilities in two districts in Tanzania between 2018 and 2019. In total, 694 pregnant women with gestational age between 32 and 40weeks and expecting vaginal delivery were consecutively recruited and assessed for FoB and DS. We collected data through interviews using 6 and 4-points Likert Scale of the Wijma Delivery Expectancy Questionnaire Version A and Edinburgh Postnatal Depression Scale, respectively. Women who scored ≥66 and≥10 were categorised as having FoB and DS, respectively. We performed multivariable logistic regression to investigate the predictors of FoB and DS. Results: The prevalence rates of FoB and DS among pregnant women were 15.1 and 17.7%, respectively. FoB and DS were more likely in women aged above 30 years [Adjusted Odds Ratio (AOR) 6.29, 95%CI 1.43–27.84] and in single mothers (AOR 2.57, 95%CI 1.14–5.78). Women with secondary education and above (AOR 0.22, 95%CI 0.05–0.99) and those who had given birth previously (AOR 0.27, 95% CI 0.09–0.87) were less likely to have FoB in combination with DS Women who had previous obstetric complications, and those who did not receive any social support from male partners in previous childbirth were more likely to have FoB and DS. FoB was strongly associated with DS (AOR 3.42, 95%CI 2.12–5.53). DS only was more common in women who had inadequate income (AOR 2.35, 95%CI 1.38–3.99) or had previously experienced a perineal tear (AOR 2.32, 95%CI 1.31–4.08). Conclusions: Not having a formal education, having only primary education, being aged above 30 years, being single, being nulliparous, having experienced obstetric complications, and having a lack of social support from a male partner during previous pregnancy and childbirth were predictors of FoB and DS during pregnancy. FoB and DS were strongly associated with each other. It is vital to identify at-risk women early, to ofer support during pregnancy and childbirth

How communication can help women who experience a maternal near-miss: a qualitative study from Tanzania

Objectives This study aimed to explore experiences of communication as an element of quality of care, among women surviving a maternal near-miss event, thus women who nearly died but survived haemorrhage, or pre-eclampsia complication during pregnancy, childbirth or within 42 days of termination of pregnancy. Design A descriptive, phenomenological, qualitative study using semistructured interviews with women who survived a maternal near-miss in Southern Tanzania. Setting The participants were recruited from two selected hospitals in Mtwara Region, where women sought child birth care and developed near-miss condition. Participants Participants for this study were women who experienced and survived a maternal near-miss event and who had lived in the study area for at least 1 year. Women were recruited using an adapted version of the WHO criteria for maternal near-miss. Data collection We identified 16 women and were able to conduct 10 in-depth interviews with women at their homes, 4 weeks after they were discharged. The interviews were audiorecorded and transcribed and translated word for word from Kiswahili. Thematic analysis was used to identify emerging themes. Results Three major themes evolved: (1) Being informed about the care and interaction, (2) Being engaged and encouraged and (3) Being afraid to ask questions. The study highlighted that good communication with women during the provision of care helped women feel grateful, supported and cared for. Women who were unconscious during care were often not informed later of what happened. This created some negative feelings and anxiety. Conclusion This study highlights the importance of communication, and of being informed of what happened and why. Empathetic communication with sufficient explanation on what happened and why created trust among women-a positive finding which should encourage the development of consistent approaches to strengthen healthcare provider communication skills

Breastfeeding and HIV: experiences from a decade of prevention of postnatal HIV transmission in sub-Saharan Africa

Infant feeding by HIV-infected mothers has been a major global public health dilemma and a highly controversial matter. The controversy is reflected in the different sets of WHO infant feeding guidelines that have been issued over the last two decades. This thematic series, 'Infant feeding and HIV: lessons learnt and ways ahead' highlights the multiple challenges that HIV-infected women, infant feeding counsellors and health systems have encountered trying to translate and implement the shifting infant feeding recommendations in different local contexts in sub-Saharan Africa. As a background for the papers making up the series, this editorial reviews the changes in the guidelines in view of the roll out of prevention of mother to child transmission (PMTCT) programmes in sub-Saharan Africa between 2001 and 2010