Unlock the drivers of early ANC visits among pregnant women in Kasulu town council, Tanzania: an institutional cross-sectional study.

Background: Maternal and child mortality remains a global public health challenge. Thus, countries, including Tanzania, have adopted different cost-effective models, especially antenatal care (ANC) to improve maternal and child health (MCH). Despite the early timing of ANC visits having a great implication for ensuring improved MCH services, Tanzania has disproportionately experienced late ANC visits among pregnant women. This has entailed conducting an institutional-based study in Western Tanzania, Kasulu Town Council (KTC) to ascertain whether demographic socio-economic and maternal characteristics imply the persistence of late ANC visits using robust methods.

Methods: An institutional cross-sectional study design was conducted in KTC, Kigoma Region using an embedded mixed-method approach from March-April 2020. Quantitative data was collected from 320 women with children aged 0-6 months attending postnatal services. A total of 40 participants were involved in the qualitative study through in-depth interviews with healthcare providers and focus group discussions held with pregnant women and women with children aged 0-6 months. Descriptive statistics and multivariate binary logistic regression were used to determine the characteristics associated with the timing of ANC visits among pregnant women. Furthermore, thematic analysis was used to generate themes triangulated with quantitative results.

Results: Findings revealed that 32.2% of pregnant women attended ANC visits in the first trimester. Early ANC was associated with maternal age (AOR = 1.839, 95% Cl: 1.023, 3.303), being accompanied by a partner (AOR = 2.165, 95% Cl: 1.256, 3.733), and awareness of the danger signs (AOR = 2.079, 95% Cl: 1.172, 3.687) and parity (AOR = 2.164, 95% Cl: 1.091, 4.291). Little association was noted in the knowledge of ANC timing (AOR = 0.564, 95% Cl: 0.320, 994) and household income (AOR = 0.529, 95% Cl: 0.281, 0.995). Qualitative data indicated that low rate of early ANC initiation was attributed to a lack of support from partners and accompanied to ANC visits, insufficient knowledge of the timing of early ANC visits, and socio-cultural beliefs.

Conclusion: Results confirmed that early ANC visit in KTC is low. Revealed associated factors act as a bridge to improve maternal and newborn health and contribute to achieving Sustainable Development Goal no 3, which targets maternal mortality of less than 70 deaths per 100,000 live births and neonatal mortality of 12 per 1000 live births by 2030. Proposed integrated interventions can potentially ensure that women, regardless of pregnancy status, are encouraged to receive early ANC utilisation during the first trimester to receive antenatal care before delivery to improve maternal and newborn health.