BackgroundThere 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.MethodsThis 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.ResultsThe 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.ConclusionThis 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.

Background Alcohol use during pregnancy is high despite the well-established evidence on its adverse pregnancy outcomes and poor child development. Early identification and behavioural modification are of great significance. This study aimed to determine the prevalence and associated factors of alcohol use during pregnancy among women in Dodoma region. Methods 365 randomly selected pregnant women attending antenatal care services in Dodoma region were included. Structured questionnaires were used to assess sociodemographic characteristic and alcohol use. Both descriptive and inferential analyses were used to estimate the prevalence and independent relationships of factors associated with alcohol use in pregnancy, respectively. Results Results showed a prevalence of 15.1% out of the 365 women attending antenatal services in Dodoma region. Prepregnancy alcohol use and having relatives who use alcohol were associated with alcohol use (AOR= 5.19; 95% CI: 4.791-34.867 and AOR=1.57; 95% CI: 1.393-6.248), respectively. Moreover, other associated factors included low education status (AOR=10.636; 95% CI: 1.89-19.844), making local brews as a source of income (AOR=11.44; 95% CI: 1.008-19.86), and not having had complications in previous pregnancies (AOR=4.93; 95% CI: 1.031-23.59). Conclusion There is a significantly high prevalence of alcohol use during pregnancy in Dodoma. Social networks and low social, economic status were associated with alcohol use in pregnancy. There is a need for public health interventions to address alcohol use particularly targeting women of reproductive age with low socioeconomic status.

BackgroundInadequate knowledge of birth preparedness and complication readiness (BPCR) among expecting couples delays timely access to maternal emergency services. The aim of this study was to assess knowledge on birth preparedness and complication readiness and how men and women differ" among expecting couples in a rural setting of Rukwa Region, Tanzania.MethodsA community-based cross-sectional study targeting pregnant women and their partners was performed from June 2017 to October 2017. A total of 546 couples were sampled using three-stage probability sampling techniques and then interviewed using a structured questionnaire. The mean score difference was sought using independent t-test. Multiple linear regressions were performed to determine the predictors of knowledge.ResultsThere was a significant difference in mean knowledge scores between pregnant women (M = 5.58, SD = 4.591) and male partners (M = 4.37, SD = 4.285); t (1085) = -4.525; p<0.001. Among women, BPCR levels were positively influenced by age (β = 0.236; p<0.01), having ever heard about birth preparedness (β = 0.176;p<0.001), being of Mambwe ethnicity (β = 0.187; p<0.001), living near a health center rather than a dispensary (β = 0.101;p<0.05) and having had a prior preterm delivery (β = 0.086;p<0.05). Access to media through radio ownership negatively influenced BPCR levels among both women (β-.119; p<0.01) and men (β = -0.168; p<0.0001). Among men, the BPCR knowledge was only positively influenced by having ever heard about birth preparedness (β = 0.169;p<0.001), age at marriage (β = -0.103; p<0.05), and having completed either primary (β = 0.157;p<0.001) or secondary education (β = 0.131;p<0.01).ConclusionSome important predictors of knowledge were revealed among women and men, but overall knowledge about birth preparedness and complication readiness was low. This study demonstrates inadequate knowledge and understanding at the community level about key elements of birth preparedness and complication readiness. In order to improve access to life-saving care for women and neonates, there is a pressing need for innovative community strategies to increase knowledge about birth preparedness and complication readiness. Such strategies are essential in order to reduce maternal and neonatal mortality in rural Tanzania.

Background In Tanzania, the uptake of optimal doses (≥ 3) of sulfadoxine-pyrimethamine for intermittent preventive treatment of malaria (IPTp-SP) during pregnancy has remained below the recommended target of 80%. Therefore, this study aimed to investigate the predictors for the uptake of optimal IPTp-SP among pregnant women in Tanzania. Methods This study used data from the 2015–16 Tanzania demographic and health survey and malaria indicator survey (TDHS-MIS). The study had a total of 4111 women aged 15 to 49 who had live births 2 years preceding the survey. The outcome variable was uptake of three or more doses of IPTp-SP, and the independent variables were age, marital status, education level, place of residence, wealth index, occupation, geographic zone, parity, the timing of first antenatal care (ANC), number of ANC visits and type of the health facility for ANC visits. Predictors for the optimal uptake of IPTp-SP were assessed using univariate and multivariable logistic regression. Results A total of 327 (8%) women had optimal uptake of IPTp-SP doses. Among the assessed predictors, the following were significantly associated with optimal uptake of IPTp-SP doses; education level [primary (AOR: 2.2, 95% CI 1.26–3.67); secondary or higher education (AOR: 2.1, 95% CI 1.08–4.22)], attended ANC at the first trimester (AOR: 2.4, 95% CI 1.20–4.96), attended ≥ 4 ANC visits (AOR: 1.9, 95% CI 1.34–2.83), attended government health facilities (AOR: 1.5, 95% CI 1.07–1.97) and geographic zone [Central (AOR: 5, 95% CI 2.08–11.95); Southern Highlands (AOR: 2.8, 95% CI 1.15–7.02); Southwest Highlands (AOR: 2.7, 95% CI 1.03–7.29); Lake (AOR: 3.5, 95% CI 1.51–8.14); Eastern (AOR: 1.5, 95% CI 1.88–11.07)]. Conclusions The uptake of optimal IPTp-SP doses is still low in Tanzania. The optimal uptake of IPTp-SP was associated with attending ANC in the first trimester, attending more than four ANC visits, attending government health facility for ANC, having primary, secondary, or higher education level, and geographic zone. Therefore, there is a need for health education and behavior change interventions with an emphasis on the optimal use of IPTp-SP doses.

Background: While evidence has shown an association between place of birth and birth outcomes, factors contributing to the choice of home birth have not been adequately investigated. In Tanzania more than 30% of deliveries occur out of health facilities with more than 95% of those deliveries are assisted by non-medical providers who are often unskilled. Birth assisted by unskilled birth attendants has been cited as a contributing factor for the high maternal and neonatal mortalities in low-resources countries. This study aimed at identifying determinants of choice for home birth over health facilities in Tanzania.Method: This study used the 2015-16 Tanzania Demographic and Health Survey and Malaria Indicator Survey (2015-16 TDHS-MIS) dataset. A total of 2286 women of reproductive age (15-49 years) who gave birth within one year preceding the survey were included in the analysis. Both univariate and multivariable regression analyses were used to determine predictors for the choice of home-based childbirth over health facility.Results: A total of 805 (35.2%) women had a home birth. After adjusting for confounders, the determinants for choice of home birth were the level of education [primary education, (AOR=0.666; p=0.001); secondary and higher education, (AOR=0.417; p<0.001)]in reference to no formal education; not owning a mobile phone, (AOR= 1.312; p=0.018); parity [parity 2-4, (AOR=1.594; p=0.004); parity 5 and above, (AOR=2.158; p<0.001)] in reference to parity 1; inadequate antenatal visits, (AOR=1.406; p=0.001); wealth index [poorest, (AOR=9.395; p<0.001); poorer, (AOR=7.701; p<0.001); middle, (AOR=5.961; p<0.001); richer, (AOR=2.557; p<0.001)] in reference to richest women and zones [Southern Highlands, (AOR=0.189; p<0.001); Southern, (AOR=0.225; p<0.001); Zanzibar, (AOR=2.55; p<0.001)] in reference to Western zone.Conclusion: A large proportion of women birth at home. Unskilled providers such as traditional birth attendants (TBAs), relatives or friends attend most of them. Predictors for home-based childbirth were lack of formal education, poor access to communication, poor uptake of antenatal visits, low socio-economic status, and geographical zone. Innovative strategies targeting these groups are needed to increase the use of health facilities for childbirth, thereby reducing maternal and neonatal mortality in Tanzania.