An assessment to inform programming for antenatal care services in six health facilities in Geita Region, Tanzania: a cross-sectional baseline survey
Authors: Hellar Augustino , Kinyina Alen , Sospeter Phineas , Kulindwa Yusuph , Phiri Frank , Bandio Raymond , Lyatuu Isaac , Mandali Hamid , Munga Abubakari , Kaaya Elsie , Sayo Protas , Mkini Felix , Kafuku Wilfred , Mtani Cyprian , Tumani James , Hellar James , Sukari Omari , Athumani Husna , Kapologwe Ntuli 
Published: September 2024

Abstract

Background
Globally, every two minutes, a woman dies during pregnancy or childbirth, and each day, about 6,300 newborns die. Most of these deaths are preventable. Despite global efforts to improve coverage and access to maternity care, mortality rates remain stubbornly high. The World Health Organization (WHO) recommends a minimum of eight antenatal care (ANC) contacts with early initiation during the first trimester (before 12 weeks). This baseline assessment aimed to determine the current status of ANC services in selected facilities before launching a pilot study. The pilot will focus on digital solutions, including the use of machine learning models, to facilitate prompt decision-making and early detection of maternal complications, ultimately helping to prevent complications during pregnancy.
Methods
This cross-sectional study involved an analysis of records from women attending ANC contacts at six selected health facilities from January to December 2022. Data were obtained from Health Management Information System (HMIS) registers—ANC and Labor and Delivery—and extracted from the District Health Information System 2 (DHIS2) to analyze ANC practices and maternal complications respectively. Descriptive analysis was performed using frequency/percentages A multivariate logistic analysis was conducted to identify factors associated with presence or absence of anaemia (> 11g/dl).
Results
Records from 657 women who received ANC and labour and delivery services across six health facilities were reviewed. 599 had a record of the number of contacts they had made. Only 34% of these women attended the WHO-recommended four or more ANC contacts (ANC4+), and just 19% initiated ANC during the first trimester. Additionally, 48.2% of the women with hemoglobin records (n = 440) were diagnosed with anaemia. While most women received two doses of supplemental iron for anaemia prevention, there was a notable decline in the administration of the third and fourth doses. In the multivariate analysis, women with four or more ANC visits were 2.7 times more likely to have normal haemoglobin levels than those with fewer visits. Coverage for Intermittent Preventive Treatment for Malaria (IPT) was 43.3%. Data extracted from DHIS2 showed a high proportion of postpartum haemorrhage (PPH) cases (n = 147).
Conclusion
These baseline findings highlight significant gaps in antenatal care practices and maternal health outcomes in the assessed facilities, underscoring the need for innovative approaches. Our proposed intervention, integrating artificial intelligence, group antenatal care (GANC), and community interventions, aims to enhance early ANC initiation, improve adherence to recommended visits, and predict and recognize maternal complications early, thereby improving maternal and fetal outcomes.