Sample characteristics
Results in Table 1 presents the social-demographic characteristics of women involved in this study. It was revealed that 72.99% of respondents resided in rural areas and 26.01% resided in urban areas. It was noted that 65.72% of women were aged between 20 and 34 years and 7.81% were below 20 years. As regards education, it was found that 60.62% of the respondents had primary education and 19.48% never attended any formal education. It was further revealed that 21.97% of women were from richer households, while 20.52% were from poorest households. Findings indicated further that 81.55% of the women were married and 6.43% were single. Regarding the number of children, the results indicated that 71.57% of women had between one to four children. About 50% of women adhered to the suggested number of antenatal care visits and the remaining 50% of pregnant women did not adhere to the suggested number of antenatal care visits. The percentage of the respondents was higher (67.20%) among those who reported using health facility for delivery and it was 32.80% for those who did not use health facility for delivery.
Identified clusters with high utilization of antenatal and delivery care services
A total of 608 sample points for 2015-16 TDHS-MIS data was used to test hypotheses for high and low utilization of maternal health care. Clusters with high utilization of more than four antenatal care visits and health facility delivery care are presented in Table 2 and Figure 1. A significant cluster with the high utilization of antenatal care visits was identified. The most likely cluster was detected with 305 sample points centralized at coordinates (-8.153830 S, 36.689660 E) in Morogoro Region. The cluster covers the radius 439.86km, which include Manyara, Tanga, Pwani, Lindi, Mtwara, Ruvuma, Njombe, Mbeya, Iringa, Singida, Dodoma, Tabora, Dar es Salaam, Kusini Unguja, Kaskazini Unguja and Kilimanjaro regions. Women in the most likely cluster were 67% more likely to attend more than four antenatal care visits throughout the pregnancy period compared to women in other clusters [RR=1.67, p<0.001].
Regarding the place of delivery, the study identified four clusters. The most likely cluster with sample points 210 was centralized at coordinate (-10.92180 S, 38.117580 E) in Mtwara Region. The cluster covers the radius of 545km, which include Mbeya, Iringa, Dodoma, Morogoro, Pwani, Kusini Unguja, Dar es Salaam, Lindi, Njombe, Ruvuma and Mtwara region. Women in the most likely cluster were 83% more likely to delivery at a health facility compared to women in other clusters [RR=1.83, p<0.001].
Identified clusters with low utilization of antenatal and delivery care services.
This study further identified eight and fifteen significant clusters with the lowest utilization of antenatal care and delivery care, respectively, as shown in Table 3 and Figure 2. The most likely cluster for lowest utilization of antenatal care services with 13 sample points was centralized at coordinates (-4.94153o S, 39.747700 E) in Kaskazini Pemba. The cluster covers a radius of 20.35 km, which included Kaskazini Pemba region only. Women in the most likely cluster were 62% less likely to have an adequate rate of the number of antenatal care visits compared to women in other clusters [RR= 0.38, p<0.001].
Concerning the place of delivery, the most likely cluster of low utilization of health facility delivery with 13 sample points was centralized at coordinates (-3.19546o S, 30.868750 E) in Kigoma Region. The cluster covers a radius of 127.36 km, which include Katavi, Tabora and Kigoma regions. Women in this cluster were 59% less likely to deliver at a health facility compared to women in other clusters [RR=0.41, p<0.001].
Factors related to the utilization of antenatal care and delivery care services
The finding of this study show residence areas, level of education, wealth index, the number of living children are significant for antenatal care utilization in both univariate and bivariate analysis (Table 4). The multiple logistic regression analysis shows that women with secondary and higher education level were 36% more likely to make more than four ANC visits service than uneducated women [AOR= 1.36; 95% CI= 1.14 -1.62]. It was also observed that women with primary education were 17% more likely to make more than four ANC visits than uneducated women [AOR= 1.17; 95% CI= 1.03-1.33]. The utilization of more than four ANC visits was relatively proportional to household-wealth status. Thus women from most affluent households were 38% more likely to adhere to the recommended number of ANC visits than those from richest households [AOR: 2.38, 95% CI= 1.94-2.91]. Women with more than five children were 40% less likely to utilize antenatal care services than women without children [AOR=0.60, 95% CI= 0.36-0.99, p<0.05].
The relationships between the socio-demographic characteristics and utilization of place of delivery are shown in Table 5. The results of the univariate and bivariate analysis indicate that residence, women age, level of education, household wealth index and the number of living children were related to the utilization of delivery services.
The results indicate that women who belong to rural areas were 54% less likely [AOR=0.46, 95% CI= 0.38-0.56] to use health facility delivery care than those in urban areas. Findings further revealed that women with secondary and higher educational level were 60% more likely to use health facility delivery care [AOR= 2.60, 95% CI: 2.10-3.23] compared to uneducated women. Regarding wealth indices, the odds of health facility delivery care increased with an increase in household-wealth status. Thus, women from the richest wealth status were 40% more likely to use health facility for delivery relative to women in the poorest wealth status [AOR= 5.40, 95% CI= 4.11-7.10].