Background: Men’s involvement can impact the delays in the decision to seek health care and in reaching a health facility, which are contributing causes for increased maternal mortality. Despite of the call to involve men in antenatal care, their participation is not well understood. This study aimed to determine the level of men’s involvement in antenatal care and the factors influencing their involvement in these services. Methods: A cross sectional study of 966 randomly selected men aged 18 years or older was conducted in Dodoma Region, from June 2014 to November 2015. Face to face interviews were conducted using a pretested structured questionnaire. The outcome variable was men’s involvement and was constructed from four dichotomized items which were scored zero to two for low involvement and three to four for high involvement. A multiple logistic model was used to measure the factors influencing men’s involvement in antenatal care services. Results: The level of men’s involvement in antenatal care was high (53.9%). Majority 89% of respondents made joint decisions on seeking antenatal care. More than half (63.4%) of respondents accompanied their partners to the antenatal clinic at least once. Less than a quarter (23.5%) of men was able to discuss issues related to pregnancy with their partner’s health care providers. About 77.3% of respondents provided physical support to their partners during the antenatal period. Factors influencing men’s involvement in antenatal care were occupation (AOR = 0.692, 95% CI = 0.511-0.936), ethnicity (AOR = 1.495, 95% CI = 1.066-2.097), religion (AOR = 1.826, 95% CI = 1.245-2.677), waiting time (AOR = 1.444, 95% CI = 1.094-1.906), information regarding men’s involvement in antenatal care (AOR = 3.077, 95% CI = 2.076-4.562) and men’s perception about theattitude of health care providers (AOR = 1.548, 95%CI = 1.090-2.199). Conclusion: Overall, more than half of respondents reported high involvement in antenatal care services. Access to information on men’s involvement, religion, occupation, ethnicity, waiting time and men’s perception about the attitude of care providers were significant factors influencing men’s involvement in antenatal care services in this study. Health promotion is needed to empower men with essential information for meaningful involvement in antenatal care services.
The study was conducted in Dodoma Region, Central Tanzania. Dodoma Region is located in central part of Tanzania, covering an area of 41,310 km2, with a population of 2,083,588 people and population density of 50 people per square kilometers [35]. The region’s health care service structure is made up of seven hospitals, 32 health centers and 269 dispensaries, most of which provide antenatal care services. The area was selected because it is a lower resource region and represents cultural aspects of male dominance and women dis-empowerment and that limited studies have addressed this phenomenon to date. It was assumed that studying the level of men’s involvement in ANC in Dodoma Regionwould provide a broad picture of the study findings from different cultures in Tanzania.The region has seven Districts: Bahi, Chamwino, Chemba, Kondoa, Kongwa and Mpwawa districts as well as Dodoma Municipality. Four Districts namely, Kondoa, Kongwa, Chamwino and Dodoma Municipality were purposively selected as regional representative of the distinctive characteristics of each district regarding male involvement. The study design was a quantitative cross-sectional survey. The study involved married men aged 18 years and above, who had children aged two years or below at the child’s last birthday. The men must have resided with their spouse together in the same household and their partners must have had a second or more pregnancy at the time of data collection. The data were collected from June 2014 to November 2015. The sample size was obtained using the Kish Leslie’s formula [36] as shown below. Where by: N ═ required sample size, t ═ confidence level at 95% (standard value of 1.96), p ═ estimated prevalence of men attendance at ANC which was 46% from previous study [37], m ═ margin of error at 5% (standard value of 0.05) and D = design effect (assumed to be 2) The minimum sample size was 764 respondents. The sample was further increased by 10% to account for contingencies such as non-response or recording error resulting to a total sample of 841. Respondents were recruited into the study through a household survey. A multistage sampling technique was used for selecting the sample units. In the first step, the four districts werepurposively selected out of seven districts. In the second step, two wards (sub divisions) were randomly chosenfrom each district using a table of random numbers to make a total of eight wards. In the third step, one village or street (in case of municipality) were chosen randomly from each of the eight wards using a table of random numbers, making a total of six villages and two streets namely; Mnenia and Pahi (Kondoa), Mlanga and Makang’wa (Kongwa), Mlowabarabarani and Chinangali-II (Chamwino) and Msalatoand Nzuguni (streets) (Dodoma Municipality). In each selected villages and streets, 105 eligible households were chosen to participate in the study which makes a total of 840 households. Systematic sampling technique with the starting point obtained using a table of random number was used to select the houses in each village or street. The sampling interval of three was used to pick the house. The first house to be interviewed was randomly selected by randomly pointing in the random number table while eyes closed so as to obtain the starting number. From the first house, every third house was selected till sample size was obtained. The direction of movement was determined by random selection. In the household if a man had more than one partner with a child born within the past two years, the interview was conducted based on the information from the youngest child. A pre-tested, structured, interviewer-administered questionnaire was used to collect the data. The questionnaire was developed by the researchers, it consisted of both open and close ended questions and it was divided into two parts. The first part captured information on household social demographic variables. The second part assessed the level of men’s involvement in ANC. The questionnaire was prepared in English and translated into Swahili. To ensure accuracy in the translation, the questionnaire was back translated into English by two independent nursing officers who were familiar with ANC in Dodoma. Pre-testing of the tool which involved 100 men was carried out at Ng’ong’hona village which is located in Makulu Ward in Dodoma Municipality. The questionnaire was administered by eight trained research assistants who were community development workers from the four Districts involved in the study. The dependent variable (men’s involvement in ANC) was constructed as a single variable to obtain the involvement index by using four dichotomized (yes/no) variables namely: 1) accompanying partner to antenatal care services, 2) providing physical support during antenatal period, 3) joint planning of when and where to seek antenatal care,and 4) discussingmaternal health issues with health care providers during antenatal period. The variable physical support was measured by asking the respondents the following question: – How did you share household work with your partner compared to the times when she is not pregnant? The responses were as follows; (1) the same work (2) more than usual and (3) not at all. Those who answered options (1, 2) were regarded as having provided physical support to their partners while option (3) was regarded as no physical support to their partners. The responses were coded as “yes” for physical support and “no” for no physical support. To obtain the level of men’s involvement in ANC by using the above mentioned four variables, each variable scored one if performed and zero if not performed. A total score was calculated by adding the score of each activity reported to be performed by a respondent. The level of involvement was classified as follows: a score of zero to two was regarded as a low level of involvement, a score of three to four as high level of involvement. Previous studies applied this approach of categorization [38, 39]. Attitudes were measured by asking the respondentsthe following question: How do you find the attitude of health workers towards men who accompany their wives to hospital to seek care? The question had two options:1) They attend to us very well and friendly and 2) They are unfriendly. Those who answered option one had a positive attitude and number two were regarded as having a negative attitude. Data were entered and analyzed by using Statistical Package for Social Sciences (SPSS Version 21.0). Univariate analysis was performed to obtain frequency and percentage for the demographic variables and the level of involvement in different activities of antenatal care. Chi-square test was performed to draw out possible associations between the men’s involvement and background characteristics. Bivariate and multivariatelogistic regression analysis was carried out to determine the factors influencing men’s involvement in antenatal care. The significance level was set at a p-value of < 0.05.
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