Maternal and household characteristics as determinants of maternal health seeking along the continuum of care in rural Tanzania

Abstract

Four antenatal care (ANC) visits, delivery in a health facility, and three postnatal care (PNC) visits are the global recommendations for mothers to optimize maternal health outcomes.[i] While these are each vital to maternal health, most existing studies analyze health seeking behavior for each level separately (ANC, health facility delivery, and PNC), without assessing health seeking along the full continuum of care. This study aims to characterize what determines a mother’s achievement of the recommended maternal health visits in three districts of rural Tanzania to illuminate strategic programmatic interventions to improve maternal health. [i] WHO. (1998). Postpartum care of the mother and newborn: a practical guide. Geneva: World Health Organization, Maternal and Newborn Health/Safe Motherhood Unit Data for this study were extracted from a cross-sectional household survey conducted between May and July 2011 by the Connect Project—a randomized cluster trail implemented by Columbia University and Ifakara Health Institute in Rufiji, Ulanga, and Kilombero districts of Tanzania to test the impact of paid community health workers on maternal and child health. 2,183 households yielded 915 women who were eligible for analysis since they had given birth within two years preceding the survey. Univariate, bivariate, and multivariate multinomial logistic regression analyses were utilized to assess relationships between maternal and householdlevel characteristics and maternal health seeking behavior. The outcome of interest was defined into three categories: highest (recommended): 4+ ANC visits and delivery in health facility and 1+ PNC; lowest: 0-3 ANC and delivery outside of health facility and 0-1 PNC; middle: all other care patterns. Preliminary findings indicate that 19.1% of women achieved the highest level, 67.9% achieved the middle level, and 13.0% achieved the lowest level. Multivariate analysis revealed parity as a significant predictor of care-seeking with women in their first pregnancy being 5.73 times (95% CI: 1.99-15.96; p < 0.001) more likely to achieve the recommended level of care and 3.49 times (95% CI: 1.37-9.38; p < 0.01) more likely to achieve the middle level of care than the lowest level. Wealth Index was also a significant predictor of health seeking behavior with those in the highest wealth index being 4.11 times (95% CI: 1.86-9.11; p < 0.000) more likely to achieve the recommended level of care and 3.13 times (95% CI: 1.57-6.25; p < 0.001) more likely to achieve the middle level than the lowest level. By determining differences between mothers achieving the full recommended maternal health visits versus those achieving less optimal levels, we recommend that maternal health interventions target multigravida and low-income mothers to achieve the greatest impact in increasing achievement of all recommended maternal health visits along the continuum of care in rural Tanzania.