On the way to universal coverage of maternal services in Iringa rural District  in Tanzania. Who is yet to be reached?.

Manuela Straneo , Piera Fogliati, Ingrid Pellis, Catherine Goodman, Donata Dalla Riva, Firma Kisika, Ezekiel Mpuya, Giovanni Putoto
1. Doctors with Africa- CUAMM, Tanzania.
2. London School of Hygiene and Tropical Medicine.
3. Iringa District Council, Reproductive and Child Health, District Medical Office.
4. Regional Medical Office, Iringa Region.

Abstract
Background: Strategies to tackle maternal mortality in sub-Saharan Africa include expanding coverage of reproductive services. Even where high, more vulnerable women may not access services. No data is available on high coverage determinants. We investigated this in Tanzania in a predicted high utilization area.

Methods:Data was collected through a household survey of 464 women with a recent delivery. Primary outcomes were facility delivery and ≥4 ANC visits. Determinants were analysed using multivariate regression.

Results: Almost all women had attended ANC, though only 58.3% had ≥4 visits. ≥4 visits were more likely in the youngest age  group (OR 2.7 95% CI 1.32–5.49, p=0.008), and in early ANC attenders (OR 3.2 95% CI 2.04–4.90, p<0.001). Facility delivery  was greater than expected (87.7%), more likely in more educated women (OR 2.7 95% CI 1.50–4.75, p=0.002), in those within  5 kilometers of a facility (OR 3.2 95% CI 1.59–6.48, p=0.002), and for early ANC attenders (OR 2.4 95% CI 1.20–4.91, p=0.02).

Conclusion:Rural contexts can achieve high facility delivery coverage. Based on our findings, strategies to reach women yet  unserved should include promotion of early ANC start particularly for the less educated, and improvement of distant communities’ access to facilities.

Keywords:Maternal health services, delivery/obstetric, utilization, prenatal care, Tanzania, Africa, south of the Sahara.