Late antenatal booking among pregnant women and its influence on intermittent preventive treatment for malaria in Ilala municipal council, Dar es Salaam region.

The World Health Organization (WHO) recommends at least four antenatal care (ANC) visits to all pregnant women with no complications during pregnancy. The ANC clinics are spaced in four weeks, each visit among other services, providing medications/supplements like iron folic and IPTp. At least three doses of SP (IPT3+) have been associated with controlling malaria during pregnancy, and may effectively be achieved if the first visit starts during the first trimester. In Tanzania only 24% of pregnant women starts attendance to ANC during the first trimester. This study aimed to understand individual, community and health system factors that lead to the delay in seeking Antenatal Care Services among pregnant women in Ilala Municipal in Dar es Salaam region, Tanzania. A qualitative exploratory study, using in-depth interviews with 20 pregnant women and 5 health care workers was conducted at Reproductive and Child Health Care clinics in three different health facilities to gather information about factors influencing late booking to antenatal care clinics among pregnant women in Ilala Municipal council. Thematic analysis was used to analyse the data. The study found out that, Individual perceptions and attitudes, past experience in pregnancy, fear of HIV tests, economic constrains, lack of family support, and awareness to both men and pregnant women were the key individual and social factor for the late ANC booking. In addition, health system factors mainly: small numbers of trained health care workers, long waiting time at the clinic, the partner’s escort policy, and negative attitudes of health care workers towards pregnant women were the main factors affecting early ANC booking among pregnant women. These factors subsequently affected realization of IPT3+ to protect pregnant women against malaria during pregnancy. Since, Individual perceptions and health system practices are the main barriers to early ANC booking with a small contribution of community norms and beliefs, it is recommended that advocacy to increase awareness to both women of reproductive age and healthcare workers should be continuous to change negative perceptions and ensure professional conducts. The government should also make efforts to address health system related factors such as long distance to the ANC clinics.