From missed visits to missed tests: determinants of antenatal care non-attendance and mother-to-child HIV transmission risk among pregnant women in Tanzania: a population-based cross-sectional study

Abstract

Antenatal care is essential for preventing mother-to-child HIV transmission and improving maternal and child health in Tanzania. However, many pregnant women do not attend ANC, leading to missed HIV testing and increased transmission risk. This study examined the association between ANC non-attendance and missed HIV testing and identified factors associated with ANC non-attendance among pregnant women in Tanzania. The study used data from the 2022 Tanzania Demographic and Health Survey and Malaria Indicator Survey, analyzing a weighted sample of 5,431 women. Descriptive analysis estimated the proportion of women who never attended ANC, while logistic regression was used to examine the association between ANC non-attendance and missed HIV testing and to identify predictors of ANC non-attendance. In Tanzania, 609(10.4%, at 95% CI = 10.0%-11.6%) of pregnant women never attended ANC. Not attending ANC was significantly associated with never tested for HIV, (aOR = 4.752 at 95% CI = 3.446–6.553, p < 0.001), age category of a woman [20-24years (aOR = 1.943at 95% CI = 1.261–2.993, p = 0.003), 25-29years (aOR = 1.938, at 95% CI = 1.206–3.114, p = 0.006), 30–34 (aOR = 2.661,at 95% CI = 1.600-4.427, p < 0.001), 35–39 (aOR = 2.518, at 95% CI = 1.453–4.366, p = 0.001), 40–44 (aOR = 2.184, at 95% CI = 1.172–4.072, p = 0.014) and 45–49 (aOR = 2.897, at 95% CI = 1.268–6.616, p = 0.012)]; Zone of residence [Northern zone (aOR = 1.465, at 95% CI = 1.053–2.037, p = 0.023), Central zone (aOR = 0.181, at 95% CI = 0.107–0.306 p < 0.001), Southern zone (aOR = 0.055, at 95% CI = 0.013–0.232 p < 0.001), Lake zone (aOR = 0.409, at 95% CI = 0.303–0.553 p < 0.001), Eastern zone (aOR = 0.522, at 95% CI = 0.345–0.791, p = 0.002) and Zanzibar zone (aOR = 0.1 at 95% CI = 0.028–0.358, p < 0.001)]; respondent working status, not working (aOR = 2.522, at 95% CI = 2.069–3.074 p < 0.001), and never used anything to prevent or delay pregnancy (aOR = 2.373, at 95% CI = 1.908–2.952, p < 0.001). In Tanzania, a notable proportion of pregnant women did not attend antenatal care, which significantly increased the likelihood of never being tested for HIV. Non-attendance was associated with maternal age, zone of residence, employment status, and prior contraceptive use. Targeted interventions addressing older women, unemployed women, and those with no history of contraception use, particularly in high-risk zones, are crucial. Enhancing community outreach and ensuring equitable access to ANC services could significantly reduce missed visits, promote early HIV testing, and improve maternal and neonatal health outcomes.