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Association Between Male Involvement During Antenatal Care and Use of Maternal Health Services in Mwanza City, Northwestern Tanzania: a Cross-­ Sectional Study

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Association Between Male Involvement During Antenatal Care and Use of Maternal Health Services in Mwanza City, Northwestern Tanzania: a Cross-­ Sectional Study Open access Original research BMJ Open: first published as 10.1136/bmjopen-2019-036211 on 6 September 2020. Downloaded from Association between male involvement during antenatal care and use of maternal health services in Mwanza City, Northwestern Tanzania: a cross- sectional study Clara C Natai,1 Neema Gervas,1 Frybert M Sikira,1 Beatrice J Leyaro ,2 Juma Mfanga,3 Mashavu H. Yussuf ,1 Sia E Msuya2,4 To cite: Natai CC, Gervas N, ABSTRACT Strengths and limitations of this study Sikira FM, et al. Association Background Male involvement in antenatal care (ANC) is between male involvement among interventions to improve maternal health. Globally The study had some strengths and limitations that have during antenatal care and male involvement in ANC is low and varies in low- income use of maternal health to be considered when interpreting the results. and middle- income countries including Tanzania where services in Mwanza City, ► One of the strengths of this study was record review most maternal deaths occur. In Sub- Sahara, men are chief Northwestern Tanzania: a cross- of women’s antenatal care (ANC) card. This helped decision makers and highly influence maternal health. In sectional study. BMJ Open with the information on ANC care use; frequency and Tanzania information is limited regarding influence of male 2020;10:e036211. doi:10.1136/ delivery and postnatal care information. We recruit- involvement during ANC on utilisation of maternal health bmjopen-2019-036211 ed women who were attending for postnatal care services. Prepublication history for services and who delivered in past 1 year to assess ► Objectives To determine the effect of male involvement this paper is available online. the association of male participation and use of during ANC on use of maternal health services in Mwanza, To view these files, please visit maternal health services. The coverage of vaccina- Tanzania. the journal online (http:// dx. doi. tion service in Mwanza region is at 70%. We might Design A cross- sectional study conducted from June to org/ 10. 1136/ bmjopen- 2019- have therefore missed a proportion of those who do July 2019. 036211). not bring children for vaccination and/or for growth Setting This study was conducted at seven randomly monitoring and therefore overestimated the use of Received 06 December 2019 selected health facilities providing reproductive, maternal http://bmjopen.bmj.com/ maternal health services. Revised 05 June 2020 and child health (RCH) services in Mwanza City. ► Men with partners who delivered in past 1 year in Accepted 07 August 2020 Participants Included 430 postpartum women who delivered the community would have been a better population 1 year prior to the study and attending for RCH services to answer questions of participation and challenges. (growth monitoring, vaccination, postpartum care). Time and difficulty in getting them limited our ability Outcome measures 4 or more ANC visits, skilled birth to use this population. attendant (SBA) use during childbirth and postnatal care ► Due to the cross- sectional nature of our study, we (PNC) utilisation 48 hours after delivery. were unable to infer causal inferences. Methods Interviews and observation of the women’s ANC card were used to collect data. Data was entered, cleaned on September 25, 2021 by guest. Protected copyright. and analysed by SPSS. Results The mean age of participants was 25.7 years. INTRODUCTION Of 430 women, 54.4% reported their partners attended Male involvement in maternal, newborn ANC at least once, 69.7% reported they attended for and child health as well as other sexual and four or more ANC visits during last pregnancy, 95% used reproductive health programmes in Africa SBAs during childbirth and 9.2% attended PNC within has been associated with improved maternal 48 hours after delivery. Male involvement during ANC was and child health outcomes.1 In many Sub- © Author(s) (or their significantly associated with four or more ANC visits (Crude Saharan African countries where maternal employer(s)) 2020. Re- use Odds Ratio (COR): 1.90; 95% CI: 1.08–3.35) but not with and newborn deaths are high, women are not permitted under CC BY-NC. No SBA use or PNC utilisation. the main decision makers. Traditionally men commercial re- use. See rights Conclusion Male involvement in ANC is still low in Mwanza, and permissions. Published by are the heads of families and have a strong as 46% of the partners had not attended with partners BMJ. influence in decision making in matters at ANC. Alternative strategies are needed to improve For numbered affiliations see participation. Studies among men are required to explore the pertaining to the use of women and children end of article. 2 barriers of participation in overall RCH services. health services. Their participation as part- Correspondence to ners in antenatal care (ANC), delivery and Dr Mashavu H. Yussuf; child services has shown considerable bene- mashay55@ gmail. com fits to women and children.3 Natai CC, et al. BMJ Open 2020;10:e036211. doi:10.1136/bmjopen-2019-036211 1 Open access BMJ Open: first published as 10.1136/bmjopen-2019-036211 on 6 September 2020. Downloaded from Studies have shown an association between male frequency of ANC visits (attend four or more visits), use involvement during pregnancy and positive uptake of of SBAs during childbirth and PNC utilisation within reproductive and maternal health services as well as 48 hours after delivery. SBA use during childbirth and positive pregnancy outcomes. In family planning, male immediate postpartum period is assessed because it is a involvement improved uptake and continuation with the key period in reducing maternal and newborn deaths.14 methods,4 while in prevention of mother- to- child HIV transmission programmes, male involvement during pregnancy is associated with increased HIV testing at METHODS ANC, uptake of prophylaxis to exposed child as well as Study design and setting 5–7 increased adherence to infant- feeding options. Male This was a cross- sectional study conducted in Mwanza City support has also shown to decrease delay in seeking care Council, Tanzania from June to July 2019. Mwanza City 6 when women have obstetric and newborn complications. Council is one of the seven districts of Mwanza region Others have shown male involvement and support during in the Lake zone. The district is bordered to the south pregnancy to increase counselling of danger signs and by Misungwi District, North by Ilemela District, west birth preparedness, increase frequency of ANC visits, by Mwanza Bay of Lake Victoria, east by Magu District. use of health facility and skilled birth attendants (SBAs) The population of Mwanza region was approximately 8 9 during childbirth. UNICEF reports that when men are 2.8 million and of Mwanza City Council was 363 452 involved in pregnancy and given nutrition counselling, according to the 2012 Census. The major economic activ- this can reduce the number of children born with low ities in Mwanza City Council are business and fishing. 9 birth weight. Mwanza City Council has a total of 63 health facilities: Despite of its advantages, proportion of male involve- 11 hospitals, 12 health centres and 40 dispensaries. Of ment in ANC is low in low-income and middle-income the 63 facilities, 46 (8 hospitals, 10 health centres and 28 countries including Tanzania where maternal and dispensaries) offer reproductive and child health (RCH) 10 11 newborn deaths are high. In Tanzania, few studies services. that evaluated male involvement in ANC show it was still In Mwanza region the use of maternal and child health 1 12 low, ranging from 34.6% to 63%. Different strategies to services is low compared with that of national level improve male participation have been implemented such according to Tanzania Demographic and Health Survey as first track services to pregnant women who attended (TDHS) (2015–2016) that is; four or more ANC visits is with their partners as shown in southern Tanzania and in at 47.6%, use of SBAs during delivery at 54%, PNC within other places opening services after work hours or in the 2 days after delivery for women is at 20.7%, vaccination weekends to accommodate men’s busy schedules. Some coverage for children at 70% and modern contracep- of the interventions showed positive outcomes while tive use at 18%; while that of national level is 51%, 64%, 10 12 others the opposite effect. 34.1%, 75% and 32%, respectively. http://bmjopen.bmj.com/ In Tanzania, while 96% of pregnant women attend at least one for ANC, only 51% attend the recommended Study population four or more ANC visits, 64% use SBAs during childbirth The study included consenting postpartum women who and 34% attend for postnatal care (PNC) within 48 hours had delivered within 1 year prior to the study and were 12 after birth. The national targets are set for 90% women attending the selected health facilities for routine RCH to reach the recommended four or more ANC visits and services. The RCH services included women bringing 12 80% deliver with SBAs by 2020. WHO now recommends children for growth monitoring and children for vaccina- that a pregnant woman without complication should have tions. Recruitment was conducted beyond the postpartum on September 25, 2021 by guest. Protected copyright. at least eight contacts with the healthcare system and visit of 48 hours in order to ensure the generalisability of 13 that first contact occurs before 12 weeks. The Tanza- findings and avoid potential bias. nian Lake zone (Mwanza region) where the study was While attendance for PNC within 48 hours is a chal- conducted has poor maternal and newborn health indica- lenge in Tanzania, majority of women attend the facilities tors compared with national level where: 47.6% of preg- for vaccination and growth monitoring of their children.
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