Factors influencing the utilisation of maternal healthcare services among reproductive-age women in Tabora region, Tanzania: an analysis of a baseline survey data from a clinical trial.

Background: Maternal health service utilisation is poor in many low- and middle-income countries, contributing to high maternal mortality rates. This study aimed to identify the key factors influencing the use of maternal health services among reproductive-age women in Tabora, Tanzania. Methods: Secondary data from a stepped-wedge clinical trial design were used. Baseline data were collected in November and December 2017 throughout Tabora. Data from 958 women aged 15-49 years in Tabora were analysed for this study. Variables analysed included maternal age, marital status, religion, household wealth status, household size, ethnicity, parity, antenatal care (ANC) visits, facility deliveries, facility distance and location (rural-urban). Descriptive analysis was used to assess the demographic characteristics of respondents and multivariate logistic regression was used to assess factors associated with the utilisation of maternal health services. Results: Achieving four or more ANC visits (ANC4+), was associated with high maternal age category (36-50 years) as compared with those aged <20 years (OR=3.13 (95% CI 1.56 to 6.31)) and least poor household wealth status (OR=1.63 (95% CI 1.11 to 2.39)) as compared with the poorest household wealth status. Facility-based delivery was associated with married women (OR=1.76 (95% CI 1.15 to 2.71)) as compared with women who were not married, low parity (<5) (OR=0.85 (95% CI 0.78 to 0.93)) as compared with high parity (>5), ethnicity (Nyamwezi) (OR=2.01 (95% CI 1.34 to 3.11)) as compared with other ethnic groups in Tabora, ANC4+ (OR=1.96 (95% CI 1.44 to 2.67)) as compared with less than four ANC visits, household wealth status; least poor (OR=2.8 (95% CI 1.81 to 4.33)) as compared with poorest household wealth status and distance (<5 km) to facility (OR=0.91 (95% CI 0.89 to 0.94)) as compared with ≥5 km. Postnatal care visits were associated with facility-based delivery (OR=6.76 (95% CI 4.71 to 9.69)) as compared with non-facility-based deliveries. Increased antenatal visits were associated with higher likelihoods of facility deliveries, which in turn led to higher postnatal care attendance. Conclusions: The findings highlight the need for targeted interventions to address the factors influencing service utilisation to improve overall maternal and child health outcomes.