PREPRINT: An assessment to inform programming for antenatal care services in six health facilities in Geita Region, Tanzania: a cross-sectional baseline survey

An Assessment to Inform Programming for Antenatal Care Services in Six Health Facilities in Geita Region, Tanzania: A Cross-Sectional Baseline Survey

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Study Overview

This baseline study assessed the delivery and use of antenatal care (ANC) services in six public health facilities in Geita Region, Tanzania. The assessment was conducted to identify gaps in ANC attendance, early pregnancy registration, preventive interventions, maternal health screening, and the reporting of pregnancy-related complications.

Researchers reviewed records from 657 women who received ANC or delivery services between January and December 2022. The study included two district hospitals, two health centres, and two dispensaries located in Chato and Geita district councils.

Data were extracted from routine Ministry of Health ANC and labour and delivery registers. Information from the District Health Information System 2 (DHIS2) was also used to examine reported maternal and newborn complications across the six facilities.

The assessment was designed to guide the development of the Mlinde Mama project, an intervention combining digital health tools, artificial intelligence-supported antenatal risk stratification, Group Antenatal Care, and community-level approaches to improve the early identification and management of pregnancy complications.

Key Findings

Among the 599 women with complete information on the number of ANC visits, only 34% attended four or more ANC contacts. This was substantially below the national estimate reported in the 2022 Tanzania Demographic and Health Survey and indicated major gaps in continued engagement with antenatal services.

Early initiation of ANC was also limited. Only 19% of women began ANC during the first trimester, while 54% initiated care between 13 and 24 weeks of pregnancy. A further 27% began care after 24 weeks.

The majority of women attending ANC were aged 18–28 years, accounting for approximately 65% of the study population. This suggests that maternal health interventions in the project area should be responsive to the needs, preferences, and barriers experienced by younger women.

Anaemia was a major maternal health concern. Among the 440 women with recorded haemoglobin results, 48.2% were anaemic. This included 25% with mild anaemia, 22.2% with moderate anaemia, and 1% with severe anaemia.

Women who attended four or more ANC visits had approximately 2.7 times higher odds of having a normal haemoglobin level than women attending fewer than four visits. Because the study was cross-sectional and relied on routine records, this finding should be interpreted as an association rather than evidence that additional visits directly caused improved haemoglobin levels.

Coverage of iron and folic acid supplementation declined with successive doses. Approximately 87% of women received the first dose and 67% received the second dose, but coverage fell to 47% for the third dose and 30% for the fourth dose.

Uptake of intermittent preventive treatment for malaria in pregnancy was also limited. Only 43.3% of women received at least three doses of preventive malaria treatment, while 14% received one dose and 16% received two doses.

Postpartum haemorrhage was the most frequently reported maternal complication across the study facilities. The DHIS2 data also showed a notably high number of reported stillbirths at one district hospital. These findings highlight the importance of strengthening clinical quality improvement, complication audits, referral systems, and routine data verification.

None of the six facilities was using an electronic health management information system at the time of the baseline assessment. This represented an important implementation gap for a project intending to introduce digital risk stratification and improve the use of maternal health data for clinical decision-making.

Programmatic Implications

The findings demonstrate the need for interventions that encourage women to begin ANC earlier and remain engaged throughout pregnancy. Community awareness, peer support, improved counselling, appointment tracking, and stronger links between community health workers and health facilities may help address barriers to timely and continued attendance.

The high prevalence of anaemia and declining completion of iron and folic acid supplementation indicate a need to strengthen nutrition counselling, commodity availability, adherence support, documentation, and follow-up during pregnancy.

Low uptake of preventive malaria treatment suggests that facilities should review the availability of medicines, eligibility assessment, provider adherence to clinical guidance, gestational timing of doses, and the quality of documentation in ANC registers.

The absence of electronic health information systems means that digital infrastructure, staff training, data-quality assurance, and workflow integration will be essential before implementing artificial intelligence-supported maternal risk stratification.

Group Antenatal Care may offer an opportunity to combine routine clinical assessment with structured health education, peer support, birth preparedness, adherence counselling, and early identification of maternal danger signs.

Conclusion

This baseline assessment identified important gaps in antenatal care utilization and maternal health service delivery in six facilities in Geita Region. Most women did not attend four or more ANC contacts, few initiated care during the first trimester, nearly half of those with haemoglobin results were anaemic, and completion of key preventive interventions declined over the course of pregnancy.

The findings provide a foundation for designing targeted interventions to improve early ANC initiation, continuity of care, anaemia prevention, malaria prevention, maternal risk identification, and management of pregnancy-related complications.

The planned integration of digital health tools, artificial intelligence-supported risk stratification, Group Antenatal Care, and community engagement may help health workers identify high-risk pregnancies earlier and provide more responsive care. However, successful implementation will require strong data systems, reliable clinical documentation, appropriate referral pathways, trained healthcare workers, and ongoing monitoring of safety, effectiveness, and equity.

Publication Details

The preprint was first published in 2025 in VeriXiv. It reports a cross-sectional baseline survey of antenatal care services in six health facilities in Geita Region, Tanzania.

The study was conducted as part of the Mlinde Mama project, funded through the Gates Foundation Grand Challenges initiative and implemented by Prime Health Initiative Tanzania in partnership with Tanzania's Ministry of Health and the government office responsible for regional administration and local government.

Suggested citation:
Hellar A, Kinyina A, Sospeter P, et al. An assessment to inform programming for antenatal care services in six health facilities in Geita Region, Tanzania: a cross-sectional baseline survey. VeriXiv. 2025;2:76. doi:10.12688/verixiv.952.1.