Abstract:
Background: It is recommended that Antenatal Care (ANC) be initiated within the first trimester of pregnancy for
essential interventions, such folic acid supplementation, to be effective. In Tanzania, only 24% of mothers attend
their first ANC appointment during their first trimester. Studies have shown that women who have had contact
with a health worker are more likely to attend their first antenatal care appointment earlier in pregnancy.
Community health workers (CHWs) are in an opportune position to be this contact. This study explored CHW
experiences with identifying women early in gestation to refer them to facility-based antenatal care services in
Morogoro, Tanzania.
Methods: This qualitative study employed 10 semi-structured focus group discussions, 5 with 34 CHWs and 5 with
34 recently delivered women in three districts in Morogoro, Tanzania. A thematic analytical approach was used to
identify emerging themes among the CHW and RDW responses.
Results: Study findings show CHWs play a major role in identifying pregnant women in their communities and
linking them with health facilities. Lack of trust and other factors, however, affect early pregnancy identification by
the CHWs. They utilize several methods to identify pregnant women, including: asking direct questions to
households when collecting information on the national census, conducting frequent household visits and getting
information about pregnant women from health facilities.
Conclusions: We present a framework for the interaction of factors that affect CHWs’ ability to identify pregnant
women early in gestation. Further studies need to be conducted investigating optimal workload for CHWs, as well
as reasons pregnant women might conceal their pregnancies.
