Browsing by Author "Joseph, Chakupewa"
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Item Factors Facilitating and Challenges Facing Community-based Interventions in Improving Antenatal Care in Rural Tanzania(Journal of Education, Humanities and Sciences, 2021) Maluka, Stephen O; Joseph, ChakupewaThe improvement of antenatal care has remained a topical global concern as signalled by maternal deaths, which have remained unacceptably high, especially in low- and middle- income countries. In response to this concern, community-based interventions through women’s groups have been implemented to improve antenatal care; and have shown promising results in rural settings. However, factors contributing to the success or failure of these interventions vary across geographical settings, thereby necessitating area- specific considerations. This paper sets out to unveil significant facilitators and barriers to the implementation of women’s group interventions in Tanzania. A qualitative case study design was employed involving interviews, focus group discussions, and documentary review in Kilolo and Mufindi districts. Eighty-six participants were interviewed and six small focus group discussions were conducted. Findings show that several factors facilitated the implementation of community-based interventions. These included recruitment and selection of the women’s groups, readiness among the women’s groups, support of the local administrative systems, and inclusive monitoring and evaluation process. On the other hand, the implementation process was constrained by insufficient logistical supplies, multiple workloads, and the desire for allowances. It is concluded that increased uptake and sustainability of antenatal care can potentially be attained through an understanding of both facilitators and barriers during the planning, development and implementation of the interventions of women’s groups.Item The Influence of Community Factors in the Implementation of Community-based Interventions to Improve Antenatal Care: A Qualitative Study Based on the IMCHA Programme in Tanzania.(BMC Reproductive Health, 2021) Joseph, Chakupewa; Maluka, StephenBackground: Efforts to improve antenatal care have been heightened to reduce global maternal deaths. In resource- limited settings, community-based interventions play a pivotal role in improving antenatal care services. However, effective implementation of community-based interventions is influenced by prevailing community-related factors. Drawing from the community-based interventions implemented in Iringa Region in Tanzania, this paper underscores how community factors influence implementation and ultimate improvement of antenatal care services. Methods: A qualitative case study design was employed using in-depth interviews, focus group discussions and document reviews. Data was collected in Kilolo and Mufindi districts in Iringa Region where community-based interventions were implemented. A total of one hundred and forty-six (146) participants were involved in the study. Eighty-six (86) participants were interviewed and sixty (n = 60) participated in focus group discussions. Data were ana- lysed thematically and manually by categorizing and coding emerging issues to facilitate analysis and interpretation. Results: Key factors that influenced the implementation of the community-based interventions were the commu- nity readiness to adopt the interventions and effective local administrative systems. Stakeholders’ engagement and local health system support were also pivotal for improving antenatal care services. However, the physical environ- ment, bullying of implementers of interventions and family-related challenges constrained the implementation of the interventions. Conclusion: This study has shown that the performance of community-based interventions is highly influenced by community-related factors. More specifically, inadequate community engagement may lead to community members’ reluctance to adopt implemented interventions. Therefore, in-depth understanding and adequate management of community engagement are important during the planning, development and implementation of community-based interventions.Item Why do pregnant women in Iringa region in Tanzania start antenatal care late? A qualitative analysis(Springer Nature, 2020-02-24) Maluka, Stephen Oswald; Joseph, Chakupewa; Fitzgerald, Sian; Salim, Robert; Kamuzora, PeterBackground: When started early in pregnancy and continued up till childbirth, antenatal care (ANC) can be effective in reducing adverse pregnancy outcomes. While the proportion of women who attend ANC at least once in low income countries is high, most pregnant women attend their first ANC late. In Tanzania, while over 51% of pregnant women complete ≥4 visits, only 24% start within the first trimester. This study aimed to understand the factors that lead to delay in seeking ANC services among pregnant women in Tanzania. Methods: This qualitative descriptive case study was conducted in two rural districts in Iringa Region in Tanzania. A total of 40 focus group discussions (FGDs) were conducted involving both male and female participants in 20 villages. In addition, 36 semi-structured interviews were carried out with health care workers, members of health facility committees and community health workers. Initial findings were further validated during 10 stakeholders’ meetings held at ward level in which 450 people participated. Data were analysed using thematic approach. Results: Key individual and social factors for late ANC attendance included lack of knowledge of the importance of early visiting ANC, previous birth with good outcome, traditional gender roles, fear of shame and stigma, and cultural beliefs about pregnancy. Main factors which inhibit early ANC attendance in Kilolo and Mufindi districts include spouse accompany policy, rude language of health personnel and shortage of health care providers. Conclusions: Traditional gender roles and cultural beliefs about pregnancy as well as health system factors continue to influence the timing of ANC attendance. Improving early ANC attendance, therefore, requires integrated interventions that address both community and health systems barriers. Health education on the timing and importance of early antenatal care should also be strengthened in the communities. Additionally, while spouse accompany policy is important, the implementation of this policy should not infringe women’s rights to access ANC services.