NU GSPP PhD Thesis Defense of Magashi Joseph Ntegwa

PhD Candidate: Magashi Joseph Ntegwa

Title: Utilization of maternal healthcare services and pregnancy outcomes in Tanzania

Abstract: In sub-Saharan Africa, maternal mortality accounts for about 70% of global maternal deaths. Utilization of Antenatal care (ANC) service is one of the cost-effective strategies to reduce maternal morbidity and mortality. Utilization of Antenatal care (ANC) service is one of the cost-effective strategies to reduce maternal morbidity and mortality. The utilization of ANC services is influenced by social determinant factors, which result in inequality in maternal health outcomes. The estimate of about 10% of adverse pregnancy outcomes in Tanzania could be reduced with adequate utilization of ANC services. Therefore, in this thesis, we identify the determinants of utilization of ANC services among pregnant women by the residential areas. Additionally, we estimate the extent to which ANC utilization impacts adverse pregnancy outcomes. Lastly, we explore the prevalence of cultural beliefs and traditional practices during pregnancy, childbirth and the postpartum period that affect the health-seeking behaviour among pregnant women. Both quantitative data —the Tanzania Demographic and Health Survey data (2004-2022) and qualitative data — Key Informant Interviews (KIIs) collected in the Simiyu region, Tanzania, are used. Results showed that women with primary education, richer household wealth status, and exposure to media (individual and community) were significantly associated with increased ANC services utilization in rural areas but not in urban areas. Also, women from rural and high-poverty communities had lower utilization of ANC services. Moreover, there was evident heterogeneity in determinants by zone of residence, showing that women's media exposure (individual and community) and women's involvement in decision-making are significantly associated with more utilization of ANC in all other zones but not in the southern, eastern and Zanzibar zones. The qualitative findings identified cultural and traditional practices, including food taboos, secrecy around pregnancy, avoidance of iron and folic acid use, and home delivery. Additionally, our estimates report that adequate ANC services utilization significantly reduces adverse pregnancy outcomes. There are evident heterogeneity effects of determinants of ANC utilization, calling for policies that are group and context-specific to address the existing inequality in the utilization of ANC care services. Moreover, adequate provision of ANC services needs to be considered in Tanzania, where health facilities are widely available.

Internal Supervisor: Riccardo Pelizzo

External Supervisor: Tan Poh Lin, NUS LKYSPP

Date: Friday, April 18

Time: 1:50 PM