Factors associated with anaemia among pregnant women in Rwanda: an analysis of the Rwanda demographic and health survey of 2020.

BACKGROUND: Anaemia in pregnancy is associated with several adverse outcomes for mothers and newborns, as well as their families. In this study, we assessed the prevalence of anaemia and the associated factors among pregnant women in Rwanda. METHODS: Secondary data from the 2020 Rwanda Demographic and Health Survey (RDHS) was used. Multistage stratified sampling was used to select 435 pregnant women included in the study. Anaemia among pregnant women was defined as a haemoglobin value < 11 g/dL. Multivariable logistic regression was used to assess the associated factors with anaemia in pregnancy, using SPSS (version 26). RESULTS: Of the 435 pregnant women, 24.6% (95%CI: 21.1-29.3) were anaemic (1 in 4 pregnant women). Not working (AOR = 2.45; 95%CI: 1.14-5.26), being unmarried (AOR = 1.23; 95%CI: 1.24-3.57), low wealth index (AOR = 9.19; 95%CI: 1.64-51.56), having difficulty accessing a nearby health facility (AOR = 5.40; 95%CI: 2.21-13.23), and normal body mass index (AOR = 3.33; 95%CI: 1.46-7.59) were associated with higher odds of being anaemic. However, not taking iron supplements (AOR = 0.16; 95% CI: 0.04-0.67), having no exposure to television (AOR = 0.35; 95%CI: 0.14-0.91), being from the southern region (AOR = 0.14; 95% CI: 0.03-0.66), and low husband/partner's education (AOR = 0.08; 95% CI: 0.01-0.59) were associated with lower odds of being anaemic. CONCLUSIONS: The study findings indicate a high prevalence of anaemia in pregnancy, which was associated with several socio-demographics. There is a need for setting up mobile clinics and health facilities in hard-to-reach areas for easy accessibility to early anaemia screening services. Conducting mass screening for anaemia targeting pregnant women who are not working, the unmarried, and those with a low wealth index would also be beneficial. The intake of locally available iron rich foods and/ or bio-fortified foods is also recommended.

Factors associated with HIV testing among pregnant women in Rwanda: A nationwide cross-sectional survey.

Human immunodeficiency virus (HIV) testing during pregnancy is crucial for the prevention of mother-to-child transmission of HIV, through aiding prompt treatment, care, and support. However, few studies have explored HIV testing among pregnant women in Rwanda. This study, therefore, aimed to determine the prevalence and associated factors of HIV testing among pregnant women in Rwanda. We used secondary data from the 2020 Rwanda Demographic and Health Survey (RDHS), comprising 870 pregnant women. Multistage stratified sampling was used by the RDHS team to select participants. We conducted bivariable and multivariable logistic regression to explore factors associated with HIV testing using SPSS (version 25). Of the 870 pregnant women, 94.0% had tested for HIV during their current pregnancy. Younger age (24-34 years), not working, large household size, multiple sex partners, as well as secondary, primary, and no education were associated with higher odds of HIV testing compared to their respective counterparts. However, being unmarried, belonging to the western region, having not visited a health facility, and not having comprehensive HIV knowledge were associated with lower odds of HIV testing. A high proportion of pregnant women had tested for HIV. The study revealed that individual-level factors had the greatest influence on HIV testing in pregnancy, with a few household-level factors showing significance. There is a need for maternal health stakeholders to design and develop HIV testing programs that are region-sensitive. These programs should target older, more educated, working, and unmarried women with limited HIV knowledge.

Prevalence of risk factors for human immunodeficiency virus among sexually active women in Rwanda: a nationwide survey.

BACKGROUND: The Human Immunodeficiency Virus (HIV) remains a global health burden, and despite the advancements in antiretroviral therapy and various strategies employed to curb HIV infections, the incidence of HIV remains disproportionately high among women. Therefore, this study aimed to determine the prevalence of the risk factors for the acquisition of HIV among sexually active women in Rwanda. METHODS: Secondary data from the 2020 Rwanda Demographic Health Survey, comprising 10,684 sexually active women, was used. Multistage stratified sampling was employed to select the study participants. Multivariable logistic regression was conducted to determine the associated risk factors using the SPSS (version 25). RESULTS: Of the 10,684 sexually active women, 28.7% (95% confidence interval (CI): 27.5-29.4) had at least one risk factor for HIV acquisition. Having no education (AOR = 3.65, 95%CI: 2.16-6.16), being unmarried (AOR = 4.50, 95%CI: 2.47-8.21), being from female-headed households (AOR = 1.75, 95%CI: 1.42-2.15), not having health insurance (AOR = 1.34, 95%CI: 1.09-1.65), no HIV test history (AOR = 1.44, 95%CI: 1.01-2.08), being from the poorest wealth quintile (AOR = 1.61, 95%CI: 1.14-2.27) and lack of exposure to mass media (AOR = 1.30, 95%CI: 1.07-1.58) were associated with higher odds of exposure to at least one HIV acquisition risk factor. In contrast, age groups of 25-34 (AOR = 0.56, 95%CI: 0.44-0.71) and 35-44 years (AOR = 0.62, 95%CI: 0.48-0.80), rural residence (AOR = 0.63, 95%CI: 0.49-0.81) and being from the western region (AOR = 0.67, 95%CI: 0.48-0.94) were associated with less odds of exposure to at least one HIV acquisition risk factor. CONCLUSION: More than a quarter of sexually active women in Rwanda had exposure to at least one risk factor for HIV acquisition. There is a need to maximize the use of mass media in disseminating HIV prevention and behavioral change messages. Engagement of religious leaders and promotion of HIV testing, especially among the never-testers, may be vital strategies in successful HIV prevention programs.

Comprehensive knowledge about HIV/AIDS and associated factors among adolescent girls in Rwanda: a nationwide cross-sectional study.

BACKGROUND: Limited comprehensive knowledge of HIV/AIDS is highlighted as one of the major factors linked to the high prevalence of HIV among adolescents and young girls. Thus, it is crucial to identify factors that facilitate or hinder adolescent girls from having comprehensive knowledge of HIV/AIDS. We, therefore, assessed the prevalence of comprehensive knowledge about HIV/AIDS and associated factors among adolescent girls in Rwanda. METHODS: We used secondary data from the Rwanda Demographic and Health Survey (RDHS) 2020 comprising 3258 adolescent girls (aged 15 to 19 years). Comprehensive knowledge was considered if an adolescent girl answered correctly all the six indicators; always using condoms during sex can reduce the risk of getting HIV, having one sexual partner only who has no other partners can reduce the risk of getting HIV, a healthy-looking person can have HIV, can get HIV from mosquito bites, can get HIV by sharing food with persons who have AIDS, and can get HIV by witchcraft or supernatural means. We, then, conducted multivariable logistic regression to explore the associated factors, using SPSS (version 25). RESULTS: Of the 3258 adolescent girls, 1746 (53.6%, 95%CI: 52.2-55.6) had comprehensive knowledge about HIV/AIDS. Adolescent girls with secondary education (AOR = 1.40, 95% CI: 1.13-3.20), health insurance (AOR = 1.39, 95% CI: 1.12-1.73), a mobile phone (AOR = 1.26, 95% CI: 1.04-1.52), exposure to television (AOR = 1.23, 95% CI: 1.05-1.44), and a history of an HIV test (AOR = 1.26, 95% CI: 1.07-1.49) had higher odds of comprehensive HIV knowledge, compared to their respective counterparts. However, girls residing in Kigali (AOR = 0.65, 95% CI: 0.49-0.87) and Northern (AOR = 0.75, 95% CI: 0.59-0.95) regions, and those of Anglican religion (AOR = 0.82, 95% CI: 0.68-0.99) had less odds of comprehensive knowledge compared to those in Southern region and of the Catholic religion. CONCLUSIONS: To increase the comprehensive understanding of the disease at a young age, the need for expanded access to HIV preventive education through formal educational curriculum, and mass and social media via mobile phones is highlighted. In addition, the continued involvement of key decision-makers and community actors, such as religious leaders, is vital.

Mosquito bed net use and associated factors among pregnant women in Rwanda: a nationwide survey.

BACKGROUND: In malaria-endemic countries such as Rwanda, the appropriate use of mosquito bed nets is an effective intervention for malaria prevention. Despite being one of the demographics most impacted by malaria, there is a dearth of literature on the usage of mosquito bed nets by pregnant women in Rwanda. The study aimed to assess the prevalence and associated factors for mosquito bed net use among pregnant women in Rwanda. METHODS: We used weighted data from the 2020 Rwanda Demographic and Health Survey of 870 pregnant women, and multistage stratified sampling was used to select participants. Multivariable logistic regression was conducted to determine the factors associated with mosquito bed net use, using SPSS (version 26). RESULTS: Of the 870 pregnant women, 57.9% (95%CI: 54.6-61.1) used mosquito bed nets. However, 16.7% did not use bed nets among those owning bed nets. On one hand, older age (AOR = 1.59, 95%CI: 1.04-2.44), primary education (AOR = 1.18, 95%CI: 1.07-2.23), being married (AOR = 2.17, 95%CI: 1.43-3.20), being from Kigali region (AOR = 1.97, 95%CI: 1.19-3.91), partner's education (AOR = 1.22, 95%CI: 1.13-3.41), having recently visited a health facility (AOR = 2.07, 95%CI: 1.35-3.18), and being in the third pregnancy trimester (AOR = 2.14, 95%CI: 1.44-3.18) were positively associated with mosquito bed net use. On the other hand, low wealth index (AOR = 0.13, 95%CI: 0.07-0.24), and being from Eastern region (AOR = 0.42, 95% CI: 0.26-0.66) had a negative association. CONCLUSIONS: About half of the pregnant women in Rwanda used mosquito bed nets and the usage was associated with various socio-demographics. There is a need for appropriate risk communication and continuous sensitisation to improve mosquito net use among pregnant women. Early antenatal care attendance and partner engagement in malaria prevention and mosquito net use, as well as consideration of household dynamics, are also crucial in improving not only mosquito net coverage but also utilization.

Sexual violence and associated factors among women of reproductive age in Rwanda: a 2020 nationwide cross-sectional survey.

BACKGROUND: Sexual violence against women is a global public health issue with both short- and long-term effects on the physical and mental health of women. This study aimed to determine the prevalence of sexual violence and its associated factors among women of reproductive age in Rwanda. METHODS: We used secondary data from the 2020 Rwanda Demographic and Health Survey of 1,700 participants, who were selected using multistage stratified sampling. Multivariable logistic regression was conducted to explore factors associated with sexual violence using SPSS (version 25). RESULTS: Of the 1,700 women of reproductive age, 12.4% (95%CI: 11.0-14.1) had experienced sexual violence. Justified beating (AOR = 1.34, 95%CI: 1.16-1.65), not having health insurance (AOR = 1.46, 95%CI: 1.26-2.40), not being involved in healthcare decision-making (AOR = 1.64, 95%CI: 1.99-2.70), having a husband/partner with primary (AOR = 1.70, 95%CI: 5.47-6.21) or no education (AOR = 1.84, 95%CI: 1.21-3.37), as well as having a husband/partner who sometimes (AOR = 3.37, 95%CI: 1.56-7.30) or often (AOR = 12.87, 95%CI: 5.64-29.38) gets drunk were positively associated with sexual violence. However, women from male-headed households (AOR = 0.52, 95%CI: 0.29-0.92) were less likely to experience sexual violence. CONCLUSIONS: There is a need to demystify negative culturally-rooted beliefs favouring sexual violence, such as justified beating, as well as increase efforts to promote women's empowerment and healthcare access. Moreover, engaging men in anti-sexual violence strategies is paramount to addressing male-related issues that expose women to sexual violence.

Evaluating continuum of maternal and newborn healthcare in Rwanda: evidence from the 2019-2020 Rwanda demographic health survey.

BACKGROUND: Access to a complete continuum of maternal and child health care has been recommended globally for better pregnancy outcomes. Hence this study determined the level (pooled prevalence) and predictors of successfully completing continuum of care (CoC) in Rwanda. METHODS: We analyzed weighted secondary data from the 2019-2020 Rwanda Demographic and Health Survey (RDHS) that included 6,302 women aged 15 to 49 years who were selected using multistage stratified sampling. We analyzed complete continuum of care as a composite variable of three maternal care services: at least four ANC contacts, SBA, maternal and neonatal post-natal care. We used the SPSS version 25 complex samples package to conduct multivariable logistic regression. RESULTS: Of the 6,302 women, 2,131 (33.8%) (95% CI: 32.8-35.1) had complete continuum of care. The odds of having complete continuum of care were higher among women who had exposure to newspapers (adjusted odds ratio (AOR): 1.30, 95% CI: 1.11-1.52), those belonging to the eastern region (AOR): 1.24, 95% CI: 1.01-1.52), southern region (AOR): 1.26, 95% CI: 1.04-1.53), those with health insurance (AOR): 1.55, 95% CI: 1.30-1.85), those who had been visited by a field health worker (AOR: 1.31, 95% CI: 1.15-1.49), those with no big problems with distance to health facility (AOR): 1.25, 95% CI: 1.07-1.46), those who were married (AOR): 1.35, 95% CI: 1.11-1.64), those with tertiary level of education (AOR): 1.61, 95% CI: 1.05-2.49), those belonging to richer households (AOR): 1.33, 95% CI: 1.07-1.65) and those whose parity was less than 2 (AOR): 1.52, 95% CI: 1.18-1.95). CONCLUSION: We have identified modifiable factors (exposure to mass media, having been visited by a field health worker, having health insurance, having no big problems with distance to the nearest health facility, belonging to richer households, being married and educated), that can be targeted to improve utilization of the entire continuum of care. Promoting maternity services through mass media, strengthening the community health programmes, increasing access to health insurance and promoting girl child education to tertiary level may improve the level of utilization of maternity services.

Women empowerment and health insurance utilisation in Rwanda: a nationwide cross-sectional survey.

BACKGROUND: Health insurance coverage is one of the several measures being implemented to reduce the inequity in access to quality health services among vulnerable groups. Although women's empowerment has been viewed as a cost-effective strategy for the reduction of maternal and child morbidity and mortality, as it enables women to tackle the barriers to accessing healthcare, its association with health insurance usage has been barely investigated. Our study aims at examining the prevalence of health insurance utilisation and its association with women empowerment as well as other socio-demographic factors among Rwandan women. METHODS: We used Rwanda Demographic and Health Survey (RDHS) 2020 data of 14,634 women aged 15-49 years, who were selected using multistage sampling. Health insurance utilisation, the outcome variable was a binary response (yes/no), while women empowerment was assessed by four composite indicators; exposure to mass media, decision making, economic and sexual empowerment. We conducted multivariable logistic regression to explore its association with socio-demographic factors, using SPSS (version 25). RESULTS: Out of the 14,634 women, 12,095 (82.6%) (95% CI 82.0-83.2) had health insurance, and the majority (77.2%) were covered by mutual/community organization insurance. Women empowerment indicators had a negative association with health insurance utilisation; low (AOR = 0.85, 95% CI 0.73-0.98) and high (AOR = 0.66, 95% CI 0.52-0.85) exposure to mass media, high decision making (AOR = 0.78, 95% CI 0.68-0.91) and high economic empowerment (AOR = 0.63, 95% CI 0.51-0.78). Other socio-demographic factors found significant include; educational level, wealth index, and household size which had a negative association, but residence and region with a positive association. CONCLUSIONS: A high proportion of Rwandan women had health insurance, but it was negatively associated with women's empowerment. Therefore, tailoring mass-media material considering the specific knowledge gaps to addressing misinformation, as well as addressing regional imbalance by improving women's access to health facilities/services are key in increasing coverage of health insurance among women in Rwanda.

Prevalence of adequate postnatal care and associated factors in Rwanda: evidence from the Rwanda demographic health survey 2020.

BACKGROUND: Although quality postnatal care (PNC) is a known significant intervention for curbing maternal and newborn morbidity and mortality, it is underutilized in most developing countries including Rwanda. Thus, it is crucial to identify factors that facilitate or occlude receipt of adequate PNC. This study aimed at assessing the prevalence of adequate PNC content and the associated factors in Rwanda. METHODS: We used weighted data from the Rwanda Demographic and Health Survey (RDHS) of 2020, comprising of 4456 women aged 15-49 years, who were selected using multistage sampling. Adequate PNC was considered if a woman had received all of the five components; having the cord examined, temperature of the baby measured, counselling on newborn danger signs, counselling on breastfeeding and having an observed breastfeeding session. We, then, conducted multivariable logistic regression to explore the associated factors, using SPSS version 25. RESULTS: Out of the 4456 women, 1974 (44.3, 95% confidence interval (CI): 43.0-45.9) had received all the PNC components. Having no radio exposure (adjusted odds ratio (AOR) =1.41, 95% CI: 1.18-1.68), visited by a fieldworker (AOR = 1.35, 95% CI: 1.16-1.57), no big problem with distance to a health facility (AOR = 1.50, 95% CI:1.24-1.81), and residing in the Southern region (AOR = 1.75, 95% CI: 1.42-2.15) were associated with higher odds of adequate PNC compared to their respective counterparts. However, having no exposure to newspapers/magazines (AOR = 0.74, 95% CI: 0.61-0.89), parity of less than 2 (AOR = 0.67, 95% CI: 0.51-0.86), being a working mother (AOR = 0.73, 95% CI: 0.62-0.85), no big problem with permission to seek healthcare (AOR = 0.54, 95% CI: 0.36-0.82), antenatal care (ANC) frequency of less than 4 times (AOR = 0.79, 95% CI: 0.62-0.85), inadequate ANC quality (AOR = 0.56, 95% CI: 0.46-0.68), and getting ANC in a public facility (AOR = 0.57, 95% CI: 0.38-0.85) were associated with lower odds of adequate PNC. CONCLUSIONS: Less than half of the mothers in Rwanda had received adequate PNC, and this was associated with various factors. The results, thus, suggested context-specific evidence for consideration when rethinking policies to improve adequate PNC, including a need for intensified PNC education and counselling during ANC visits, continued medical education and training of PNC providers, and strengthening of maternal leave policies for working mothers.

Utilisation of modern contraceptives by sexually active adolescent girls in Rwanda: a nationwide cross-sectional study.

BACKGROUND: Modern contraceptive use has been shown to influence population growth, protect women's health and rights, as well as prevent sexually transmitted infections (STIs) for barrier contraceptive methods such as condoms. The present study aimed at assessing the level of utilization and factors associated with modern contraceptive use among sexually active adolescent girls in Rwanda. METHODS: We used secondary data from the Rwanda Demographic and Health Survey (RDHS) 2020 data of 539 sexually active adolescent girls (aged 15 to 19 years). Multistage stratified sampling was used to select study participants. We conducted multivariable logistic regression to assess the association between various socio-demographics and modern contraceptive use using SPSS version 25. Modern contraception included the use of products or medical procedures that interfere with reproduction from acts of sexual intercourse. RESULTS: Of the 539 sexually active girls, only 94 (17.4%, 95% CI: 13.8-20.1) were using modern contraceptives. Implants (69.1%) and male condoms (12.8%) were the most used options. Modern contraceptive use was positively associated with older age (AOR = 10.28, 95% CI: 1.34-78.70), higher educational level (AOR = 6.98, 95% CI: 1.08-45.07), history of having a sexually transmitted infection (AOR = 8.27, 95% CI: 2.54-26.99), working status (AOR = 1.72, 95% CI: 1.03-2.88) and being from a female-headed household (AOR = 1.96, 95% CI: 1.12-3.43). However, not being in a union (AOR = 0.18, 95% CI: 0.10-0.35) and region (AOR = 0.28, 95% CI: 0.10-0.80) had negative associations. CONCLUSIONS: To promote utilisation of modern contraceptives, family planning campaigns need to place more emphasis on the younger, unmarried adolescents, as well as those with lower educational levels. Consideration of household and regional dynamics is also highlighted.

Factors associated with utilization of quality antenatal care: a secondary data analysis of Rwandan Demographic Health Survey 2020.

BACKGROUND: Over the last decade, progress in reducing maternal mortality in Rwanda has been slow, from 210 deaths per 100,000 live births in 2015 to 203 deaths per 100,000 live births in 2020. Access to quality antenatal care (ANC) can substantially reduce maternal and newborn mortality. Several studies have investigated factors that influence the use of ANC, but information on its quality is limited. Therefore, this study aimed to identify the determinants of quality antenatal care among pregnant women in Rwanda using a nationally representative sample. METHODS: We analyzed secondary data of 6,302 women aged 15-49 years who had given birth five years prior the survey from the Rwanda Demographic and Health Survey (RDHS) of 2020 data. Multistage sampling was used to select RDHS participants. Good quality was considered as having utilized all the ANC components. Multivariable logistic regression was conducted to explore the associated factors using SPSS version 25. RESULTS: Out of the 6,302 women, 825 (13.1%, 95% CI: 12.4-14.1) utilized all the ANC indicators of good quality ANC); 3,696 (60%, 95% CI: 58.6-61.1) initiated ANC within the first trimester, 2,975 (47.2%, 95% CI: 46.1-48.6) had 4 or more ANC contacts, 16 (0.3%, 95% CI: 0.1-0.4) had 8 or more ANC contacts. Exposure to newspapers/magazines at least once a week (aOR 1.48, 95% CI: 1.09-2.02), lower parity (para1: aOR 6.04, 95% CI: 3.82-9.57) and having been visited by a field worker (aOR 1.47, 95% CI: 1.23-1.76) were associated with more odds of receiving all ANC components. In addition, belonging to smaller households (aOR 1.34, 95% CI: 1.10-1.63), initiating ANC in the first trimester (aOR 1.45, 95% CI: 1.18-1.79) and having had 4 or more ANC contacts (aOR 1.52, 95% CI: 1.25-1.85) were associated with more odds of receiving all ANC components. Working women had lower odds of receiving all ANC components (aOR 0.79, 95% CI: 0.66-0.95). CONCLUSION: The utilization of ANC components (13.1%) is low with components such as having at least two tetanus injections (33.6%) and receiving drugs for intestinal parasites (43%) being highly underutilized. Therefore, programs aimed at increasing utilization of ANC components need to prioritize high parity and working women residing in larger households. Promoting use of field health workers, timely initiation and increased frequency of ANC might enhance the quality of care.

2030 Countdown to combating malnutrition in Burundi: comparison of proactive approaches for case detection and enrolment into treatment.

BACKGROUND: Burundi has one of the highest rates of malnutrition in the world, particularly chronic malnutrition, which affects 55% of all children <5 y of age. Although it rolled out a national treatment programme to combat all forms of malnutrition, enrolment of children remains difficult. In this study, we use observational data from two screening approaches to assess the effectiveness in detection and enrolment into treatment. METHODS: Individual data from each screening approach was classified as either acutely malnourished or normal and either chronically malnourished or normal using a cut-off z-score between -2 and 2. RESULTS: While the Global Acute Malnutrition rate for the community-based mass screening was 8.3% (95% CI 5.6 to 11), with 8% enrolled in treatment, that of clinic-based systematic screening was 14.1% (95% CI 12.2 to 16.1), 98% of which were enrolled in treatment. Clinic systematic screening was 1.82 times (OR, 95% CI 1.26 to 2.62, p<0.001) and 1.35 times (95% CI 1.09 to 1.68, p=0.06) more likely to detect acute and chronic malnutrition, respectively, than community-based mass screening. CONCLUSIONS: Although different mechanisms are relevant to proactively detect cases, strengthening the health system to systematically screen children could yield the best results, as it remains the primary contact for the sicker population, who may be at risk of increased infection as a result of underlying malnutrition.

Infant and child health status ahead of implementation of an integrated intervention to improve nutrition and survival: a cross-sectional baseline assessment.

BACKGROUND: Burundi has one of the poorest child health outcomes in the world. With an acute malnutrition rate of 5% and a chronic malnutrition rate of 56%, under five death is 78 per 1000 live births and 47 children for every 1000 children will live until their first birthday. In response to this grim statistics, Village Health Works, a Burundian-American organisation has invested in an integrated clinical and community intervention model to improve child health outcomes. The aim of this study is to measure and report on child health indicator ahead of implementing this model. METHODS: A cross sectional design was employed, adopting the Demographic Health Survey methodology. We reached out to a sample of 952 households comprising of 2675 birth, in our study area. Mortality data was analysed with R package for mortality computation and other outcomes using SPSS. Principal component analysis was used to classify households into wealth quintiles. Logistic regression was used to assess strength of associations and significance of association was considered at 95% confidence level. RESULTS: The incidence of low birth weight (LBW) was 6.4% at the study area compared to 10% at the national level with the strongest predictor being malnourished women (OR 1.4 95%CI 1.2-7.2 p = 0.043). Fever incidence was higher in the study area (50.5%) in comparison to 39.5% nationally. Consumption of minimum acceptable diet was showed a significant protection against fever (OR 0.64 95%CI 0.41-0.94 p = 0.042). Global Acute Malnutrition rate was 7.6% and this significantly reduced with increasing age of child. Under-five mortality rate was 32.1 per 1000 live births and infant mortality was 25.7 per 1000 in the catchment with most deaths happening within the first 28 days of life (57.3%). CONCLUSION: Improving child health status is complex, therefore, investing into an integrated intervention for both mother and child could yield best results. Given that most under-five deaths occurred in the neonatal period, implementing integrated clinical and community newborn care interventions are critical.

Delivery of integrated infectious disease control services under the new antenatal care guidelines: a service availability and readiness assessment of health facilities in Tanzania.

BACKGROUND: Tanzania remains among the countries with the highest burden of infectious diseases (notably HIV, Malaria and Tuberculosis) during pregnancy. In response, the country adopted World Health Organization's (WHO) latest antenatal care (ANC) guidelines which recommend comprehensive services including diagnostic screening and treatment for pregnant women during antenatal. However, as Tanzania makes efforts to scale up these services under the existing health system resources, it is crucial to understand its capacity to deliver these services in an integrated fashion. Using the WHO's service availability and readiness assessment(SARA) framework, this study assesses the capacity of the Tanzanian Health System to provide integrated Malaria, Tuberculosis and HIV services. METHODS: Composite indicators of the five components of integration were constructed from primary datasets of the Tanzanian Service Provision Assessments (SPA) under the Demographic and Health Survey (DHS) programs. Chi-squared analysis, T test and ANOVA were conducted to determine the associations of each of the defined components and background characteristics of facilities/health workers. A logistic regression model was further used to explore strength of relationships between availability of service readiness components and a pregnant women's receipt of HIV, Malaria and TB services by reporting adjusted odds ratios. RESULTS: Generally, capacity to integrate malaria services was significantly higher (72.3 95% CI 70.3-74.4 p = 0.02) compared to Tuberculosis (48.9 95% CI 48.4-50.7) and HIV (54.8 95% CI 53.1-56.9) services. Diagnostic capacity was generally higher than treatment commodities. Regarding the components of SARA integration, logistic regression found that the adjusted odds ratio of having all five components of integration and receiving integrated care was 1.9 (95% CI 0.8-2.7). Among these components, the strongest determinant (predictor) to pregnant women's receipt of integrated care was having trained staff on site (AOR 2.6 95% CI 0.6-4.5). CONCLUSION: Toward a successful integration of these services under the new WHO guidelines in Tanzania, efforts should be channelled into strengthening infectious disease care especially HIV and TB. Channelling investments into training of health workers (the strongest determinant to integrated care) is likely to result in positive outcomes for the pregnant woman and unborn child.