Factors affecting early identification of pregnant women by community health workers in Morogoro, Tanzania

Abstract

Background It is recommended that Antenatal Care (ANC) be initiated within the first trimester of pregnancy for essential interventions, such folic acid supplementation, to be effective. In Tanzania, only 24% of mothers attend their first ANC appointment during their first trimester. Studies have shown that women who have had contact with a health worker are more likely to attend their first antenatal care appointment earlier in pregnancy. Community health workers (CHWs) are in an opportune position to be this contact. This study explored CHW experiences with identifying women early in gestation to refer them to facility-based antenatal care services in Morogoro, Tanzania. Methods This qualitative study employed 10 semi-structured focus group discussions, 5 with 34 CHWs and 5 with 34 recently delivered women in three districts in Morogoro, Tanzania. A thematic analytical approach was used to identify emerging themes among the CHW and RDW responses. Results Study findings show CHWs play a major role in identifying pregnant women in their communities and linking them with health facilities. Lack of trust and other factors, however, affect early pregnancy identification by the CHWs. They utilize several methods to identify pregnant women, including: asking direct questions to households when collecting information on the national census, conducting frequent household visits and getting information about pregnant women from health facilities. Conclusions We present a framework for the interaction of factors that affect CHWs’ ability to identify pregnant women early in gestation. Further studies need to be conducted investigating optimal workload for CHWs, as well as reasons pregnant women might conceal their pregnancies. Electronic supplementary material The online version of this article (10.1186/s12889-019-7179-1) contains supplementary material, which is available to authorized users.

The social dimensions of community delivery of intermittent preventive treatment of malaria in pregnancy in Madagascar, Mozambique, Nigeria and the Democratic Republic of the Congo

“…Multiple studies have described women’s reluctance to reveal their pregnancy and how disclosing the pregnancy too early is perceived to result in harm to their unborn child or a ‘failed pregnancy’. These fears shape both their interactions with CHWs and their use of ANC services during the first trimester 47. Although these fears were decreasingly salient in participants’ accounts, pregnancy disclosure norms may persist as a relevant barrier to C-IPTp because they hinder early ANC attendance (as encouraged by the intervention), and constrain CHW identification of pregnant women in the community.…”

“…These fears shape both their interactions with CHWs and their use of ANC services during the first trimester. 47 Although these fears were decreasingly salient in participants’ accounts, pregnancy disclosure norms may persist as a relevant barrier to C-IPTp because they hinder early ANC attendance (as encouraged by the intervention), and constrain CHW identification of pregnant women in the community. Nevertheless, data also suggest that pregnancy disclosure norms were not fully disrupted by the delivery of SP through CHWs, since IPTp should be administered from the second trimester, when the belly is increasingly visible and thus harder to hide.…”

The role of community health workers in influencing social connectedness using the household model: a qualitative case study from Malawi

“…CHWs and pregnant clients noted that CHWs have similar struggles with detecting early pregnancy for robust antenatal care leading to improved pregnancy outcomes. This challenge of early pregnancy reporting also has been identified for CHWs in Tanzania [ 51 ], Malawi [ 36 ], and Uganda [ 52 ]. They identified similar concerns of losing the pregnancy and witchcraft, not wanting to tell a young female CHW without prior experience, and the expectation that a pregnant woman must first confirm the pregnancy at the facility before telling a CHW.…”

“…Despite several CHW programs working to decrease discrimination against adolescent pregnancy or incidence of adolescent pregnancy, a systematic review in 2016 showed that CHWs have very little influence in preventing adolescent pregnancy or the challenges pregnant youth face with many cultural and social implications [ 56 ]. As shown in other studies, we must aim to find facilitating factors for early pregnancy detection, such as husband involvement in screening and birth-preparedness activities, to enrich connections between the CHW, the community, and pregnant women [ 36 , 51 , 52 ]. More efforts are required to invest in multidisciplinary programming to influence the cultural cycle, including education, youth-friendly health services, and building trust in youth and their parents to prevent and support adolescent pregnancy.…”

Family Planning Uptake in Kagera and Mara Regions in Tanzania: A Cross-Sectional Community Survey

“…Women who discussed family planning with CHWs were four times more likely to use family planning and CHWs are able to build trusted relationship in the community. Being originally from the same community and making frequent household visits enhance familiarity that enables more time for health talks and women are free to discuss and express their concerns, This gives CHWs more opportunity and authority to provide relevant information about FP methods promoting family planning uptake [60]. Although only less than one in ten women discussed family planning with CHWs, their odds of FP uptake were higher.…”