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Background. Men’s involvement in maternity care is recognized as a key strategy in improving maternal health and accelerating reduction of maternal mortality. This study investigated the factors determining men’s involvement in maternity care in Dodoma Region, Central Tanzania. Methods. This cross-sectional survey used multistage sampling in four districts of Dodoma Region to select 966 married men participants aged 18 years and above. Data were collected using a structured questionnaire. Multivariate logistic regression analysis was carried out in SPSS version 21.0 to measure the determinants of men’s involvement in maternity care. Results. The study found that only 1 in 5 men were involved in maternity care of their partners. Factors found to determine men’s involvement in maternity care were having >4 children (AOR=1.658, 95%CI=1.134 to 2.422), urban area of residence (AOR=0.510, 95%CI=0.354 to 0.735), waiting time >1 hour at the health care facility (AOR=0.685, 95%CI=0.479 to 0.978), limited access to information (AOR=0.491, 95%CI=0.322 to 0.747), and limited spousal communication (AOR=0.3, 95%CI=0.155 to 0.327). Conclusions. Long waiting time to receive the service and limited access to information regarding men’s involvement are associated with low men’s involvement in maternity care. Male friendly maternity care should recognize men’s preferences on timely access to services and provide them with relevant information on their roles in maternity care. Spousal communication is important; mothers must be empowered with relevant information to communicate to their male partners regarding fertility preferences and maternity care in general.
The study was conducted in Dodoma Region. The area was selected because it is the capital of the country and a fast growing region with a cultural diversity befitting the examination of male involvement in maternity care. Therefore, it was assumed that studying the determinants of men’s involvement in maternity care in Dodoma Region would provide a broad picture of the study findings from different cultures in Tanzania. Dodoma Region has seven districts; four districts were randomly selected to be involved in the study namely: Kondoa, Kongwa, Chamwino, and Dodoma Municipality. Dodoma Region is located in central part of Tanzania, with a population of 2,083,588 people and population density of 50 people per square kilometers. It covers an area of 41,310 square kilometers [26]. Male population accounts for 48.7% of the total population. The annual population growth rate is 2.1% with a sex ratio of 95 males to 100 females [26]. The region’s health care service structure is made up of seven hospitals, 32 health centers, and 269 dispensaries, most of which provide reproductive and child health services [26]. This study employed a descriptive cross-sectional survey using quantitative research approach. It involved married men aged 18 years and above, who resided with their spouses together in the same household, whose partner had a child aged two years or below, and whose partners had second pregnancy and above at the time of data collection and was willing to participate in the study. The study was conducted between November 2016 and June 2017. Sample size was estimated using the Kish Leslie’s formula based on the following assumptions: 95% confidence level, 39.2% estimated prevalence (findings from a previous study [8]), a 5% margin of error and a design effect assumed to be 2.5 to cater for intracluster variability; the sample was further increased by 20% to account for nonresponse or recording error [27]. Therefore, the estimated total sample size was 1,099 respondents. A three-stage cluster sampling strategy was used to select a representative sample from the four districts. First, all wards in the four districts were listed and then two wards in each district were randomly selected using the ballot method, which made a total of eight wards. In the second stage, all streets and villages in the selected wards were listed and then two streets in Dodoma Municipality and two villages in each three districts (Kondoa, Kongwa, and Chamwino) were randomly selected. In stage three, list of houses was obtained and then proportionate samples were drawn from each district. A systematic sampling technique with the starting point obtained using a table of random numbers was used to select the houses. In cases where more than one household was found in a house, one household was selected by using a single one-time ballot. In the households 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. Eligible men in the sampled household were approached to participate in the study. A structured, interviewer-administered questionnaire containing open and close-ended questions was used to collect data. This data collection tool was adapted from the previous works [6, 28]. The adaptation of the questionnaire was based on the aim and objectives of our study, literature review and relevant local factors related to the research question. The questionnaire was divided into three parts. The first part captured information on household social demographic variables. The second part assessed the level of men’s involvement in maternity care during antenatal, natal, and postnatal periods. The third part assessed the determinants of men’s involvement in maternity care. Prior to data collection, the questionnaire was pretested in Bahi district, which has similar characteristics as the districts selected for study. The questionnaire was modified accordingly before being used in the study. It was administered by eight male research assistants who had recently graduated from medical school and were trained by principal investigator for 3 days before the start of data collection. The interviews were conducted in Swahili language. Prior to actual analysis of the data, the data were cleaned, validated, and analyzed using SPSS version 21.0. The dependent variable (men’s involvement in maternity care) was constructed as a single variable to obtain the involvement index using twelve dichotomized (yes/no) variables. The study assessed four activities and each activity had three variables as follows: (1) accompanies partner to antenatal, natal, and postnatal care, (2) provides physical and emotional support to his partner during antenatal, natal, and postnatal periods, (3) is involved in joint planning for antenatal care, place of delivery, and postnatal care, and (4) discusses maternal health issues with her health care providers during antenatal, natal, and postnatal periods. Factor analysis was performed to obtain male involvement index. The purpose was to measure how much each variable contributes to the outcome variable (male involvement). All twelve variables were subjected in the principal component analysis. In the first analysis four components with eigenvalues (variance) greater than one were extracted. According to “Kaiser’s rule” only those components with eigenvalues greater than one should be retained [29]. Based on Kaiser’s rule the study decided to retain the first component because it had greater eigenvalue (variance) than other components. In the first component the variables that had correlation coefficients score of less than 0.3 were excluded in the second analysis. Correlation coefficient (r) must be 0.30 or greater since anything lower would suggest a really weak relationship between the variables [30]. In this study six variables were found to have a correlation coefficient less than 0.3 which indicated a weak relationship with the outcome variable. The variables that had weak relationship were provides physical support during postnatal period, provides physical support during natal period, is involved in joint planning for place of delivery, is involved in joint planning for postnatal care, provides physical support during antenatal period, and accompanies partner to delivery of the child. These variables were excluded in the second factor analysis. The second factor analysis was performed with the remaining six variables. Two components with eigenvalues greater than one were extracted. Based on the same rule “Kaiser’s rule” the first component was retained because it had greater eigenvalue than the second component and this first component was the one used to obtain men’s involvement index score. After obtaining the scores of each respondent, the median, minimum, and maximum values of the scores were calculated as follows: mean was 0.7137965, median was 0.3460358, minimum score was -1.94712, and maximum score was 1.15192. To obtain the scores in percent the percentile was set as 0-50 low involvement and 51-100 as high involvement. Based on the median, mean, and maximum values the percentile was calculated and categorized as -1.94712 to less than 0.7137965 as low involvement and above 0.7137966 to 1.15192 as high involvement. Lastly the categories were coded as “0” for low involvement “1” for high involvement and the frequency of overall involvement score was obtained. Preventive cultural norms/taboo was measured by asking the respondents if there are any cultural norms or taboos which prevent them from accompanying their partners to the health care services and they were required to respond if it is yes/no. The variable attitude was measured by asking the respondents the following question: how do you find the attitude of health workers towards men who accompany their partners 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 negative attitude. Access to information was measured by asking the following question: have you ever heard or been told that men are supposed to attend at antenatal care services with their partners? (yes/no). Time spent while waiting for ANC service was measured by asking the following question: how long on average do you spend in the health facility when you accompany your partner for ANC service? The responses obtained were summarized into two categories (less than or equal to one hour/ more than one hour). Spousal communication was measured by asking the respondents the following question: do you discuss or ask your partner any issues related to her pregnancy and delivery? Respondents were required to answer if it is yes/no. The data was entered, cleaned, validated, and analyzed using Statistical Package for Social Sciences (SPSS Version 21.0). Variables were tabulated using frequencies and percentages. The Chi-square test was used for testing the significance of association between categorical variables. A bivariate analysis was carried out and crude odds ratios (ORs) for each variable were calculated. All variables that were significantly associated with men’s involvement in maternity care were included in a multivariate logistic regression analysis in order to determine their independent effects in maternity care. The Adjusted ORs and their corresponding 95% Confidence Interval (CI) were obtained. The level of significance was set at P < 0.05.
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