Association Between Socioeconomic Status and Antenatal Care Attendance Among Women Living in Southern Tanzania

·         Objectives – this research aimed to determine the complete ANC attendance level and the variation of complete ANC attendance by mothers’ socioeconomic status in rural southern Tanzania.

·         Design – The conceptual framework of the research is based on the integrated analysis of attendance of women in ANC clinics and quality of care provided to them. The research used cross sectional data analysis. The sampled women filled questionnaire to provide initial primary data source. The adequate ANC content was then assessing to final analysis to find the frequency of antenatal visits.

·         Participants – the data for the research was collected by 10,480 women participants from different regions of Tanzania who are participants of the research. The sample size of household survey was based women who belong to age group between 13–49 and given birth in the preceding year of survey which, as suggested by previous population surveys, was around 10%.

·         Outcome measures – key variable of the research are woman of reproductive age, consent of women for participation, woman who had ever given birth, women with year preceding with the survey, attended ANC at least for once, number of times attended ANC, age of mother, socioeconomic status, ethnic group, and years of education completed by the women.

·         Results – The research shows that higher number of educated women attended 4 times ANC. The individual level of education was greater for level 7.  In a nut shell, women of Tanzania are experiencing ANC as a key metric for the reporting of health care and it is used in the urban areas as compared to the remote areas.

·         Conclusions – One of the major issues and challenges is to provide adequate education and antenatal care ANC to the pregnant women. The research can be implemented to identify the functional gaps between the services provided to women and the level of education of women.

Results of Antenatal Care Attendance Among Women Living in Southern Tanzania

A household survey was conducted to collect data from women of age 13 – 49. The analysis was based on the samples collected from as house hold and reportable deliveries. The sample size of households was 10, 480 and for reportable deliveries it was 1,048. The research is based on 4 SES categories in which 82% were from category 4, 38% for SES category 3, 13% for SES category 2 and 53% for SES category. In the research, multistage sampling was selected from household under the areas of sub-village and villages. The response rate for all the parameters is mentioned in the table 1.

The response rate for all the parameters was 100, the frequency of woman between age 13 to 49, women having consent, those who ever given birth, and last year was 38, 950, 9, 952, 8, 202, and 6, 398 respectively. The descriptive data is also used in the analysis for antenatal care. Antenatal care (ANC) can be used to save lives. The frequency of missing ANC was higher in women as 0.59 percent denied and 99.41 agreed with the query.

The frequency and percentage results analysis concluded that number of women attending ANC for four times was 438 and 42.77 percent respectively while frequency and percentage of women attending the program for 3 times in a row was 576 and 56.25 percent respectively.  The qualification levels of women who participated in the research were level 6 qualification, level 7 and more than level 7 qualification. The maximum frequency obtained in the research was for level 7 qualified women. The frequency of level 7 was 566 with 55.27 %. The minimum frequency of 60 was obtained for higher qualifications more than level 7 with 5.86 %. The frequency of level 6 was 398 with 38.87%. The research ethnicity is Makonde, Mwera, Makuwa, Yao and others. The total frequency for ethnicity was 1, 024. The frequency and percentage of Makonde and non-makonde ethnicity was 562 with 54.88 % and 462 with 45.12 % respectively. The maximum frequency for age is observed as 50% for age group of 20 to 29 years and followed the percentage as 13.87, 50.00, 30.08, and 6.05 for age group of 15 – 19, 20 – 29, 30 – 39, and more than 40 years respectively. The statistical analysis of the collected data is mentioned in table 2.

Discussion on Antenatal Care Attendance Among Women Living in Southern Tanzania

The datasets collected in the research reflected different conditions and parameters such as age levels, education levels, and number of attended ANC programs. The research is based on regions of urban areas and remote villages to estimate how many mothers were facilitated by the recommended services. The pooled multivariate process was used in studies to estimate the advantages and disadvantages of systematic process. The research identified women benefited by ANC. The research optimized significant gaps in the functionality of quality of management and the process. The women of urban and non-village were more exposed to the education facilities and ANC. The differences are interlinked with the heterogeneity, driving factors of quality, private and religious categories and other functions. The similar results were concluded in the previous researches on Gambia, Tanzania, and Kenya. In the present results, the strong association was observed in quality of care and ANC that was provided to women. The results also analyzed the significant different in the education levels of women from lower quality areas. The relation of education with the village and non-village areas was higher. Evidences shows late pregnancy recognition, low risk appreciation, and obstacles causing issues in the solution of the problem. The variables selected in the research were woman of reproductive age, consent of women for participation, woman who had ever given birth, women with year preceding with the survey, attended ANC at least for once, number of times attended ANC, age of mother, socioeconomic status, ethnic group, and years of education completed by the women. In order to estimate the significance of collected data different tests were used. The analysis of crude test shows firm association between ANC and SES attendance. The score test was a trend between odds and quintiles. The ratio analysis was carried out for the approximation of odd ratios and for having increase in quintile. The results of odd ratio analysis are mentioned in table 3.

For the adjustment of one variable at a time, Mantel Haenzsel analysis was carried out. In this analysis, one important parameter is mother education level. The adjustment process was for age and ethnicity. Another finding showed that was worth pointing was difference between number of ANC attended. The women those attended the program for 3 times was higher. The relative difference was similar as in case of education levels. The regional differences are there that can be explained on basis of overall health service in the maternity care. For example, in different countries the level of health care is different such as in South Asia, Middle East, and Central Asian countries. The possible issues in these countries are political instabilities, improper health care systems, and lack of child health indicators that lead to poor maternal solutions. While on the other hand in the developed countries such as Caribbean and Latin America, the remarkable improvement is measured observed in the antenatal coverage. In these regions, according to the statistical analysis, remarkable number of women are receiving minimum of 4 visits and the increase was 75% in 2015 as compared to 1990.   

There are different parameters for Socio-economic status (SES) that can be measured on the basis of employment, housing structure and economic levels. The principle values are different for all the characteristics and parameters. The participants require different values and variables related to the information. The present research suggests implementation of new and diverse integrated framework that could be conceptual on different basis. The outlines of the context are based on attendance of women in ANC clinics and identifies the disadvantages of backgrounds or the quality of services delivered to the women. The empirical research was conducted on healthcare utilization along with the characteristics of users and variance. The research findings are consistent and corelated with each other that improves significance of results. The systematic variation is used with different test methods including Mantel Haenzsel analysis. The variance was estimated in the homogeneity rest of ORS. The total number of participants in ethnic group was 1014 while 558 of them were Makonde and 456 were non-makonde.

The results are based on odd ratios for all the collected data and it was completed for ANC attendance for each quintile. The increase in each quintile was associated with SES. In the 95% confidence interval the Makonde group consist of 1.07 - 1.38 and Non- Makonde group consist of 0.88 - 1.14. The difference between p value of both groups is significant. The research outcomes are significant in estimating the major concerns and barriers of that lead to prevent the women from attending the ANC appropriately. The final model disclosed issues related to health services, age facts, number of issues and other individual factors. The actual aim of the research was to find the factors related to adequacy of ANC. The ANC service decisions are often not affected by the process. The research will provide benefits to the women in remote areas as an awareness program and to improve the information levels.

Despite the other important findings of the research, there are some important limitations of the present study that are required to be mentioned. The first issue or limitation is related to the range of services and it was not analyzed in the present research. However, the researchers strongly believe that service monitoring is essentially required for urine analysis, blood pressure, blood test, tetanus injection, and information about danger signs of health. It is important to consider the iron folate supplement with ANC services delivered to the women. Secondly, there are wide dissimilarities with some of the national contexts of different countries and it is impossible to render them as inclusion of sociocultural variables such as ethnicity and religion.