Determinants of quality antenatal care utilization in Tanzania: a generalized multilevel poisson regression model approach

Abstract Despite efforts by the government of Tanzania to address the accessibility of maternal healthcare services, there are evident differences between and within regions in the utilization of antenatal care (ANC) services. Using retrospective secondary data analysis of the Tanzania Demographic and Health Survey and Malaria Indicator Survey for 2004/05, 2010, 2015/16, and 2022, this study examines the determinants of ANC utilization by place of residence and zone of residence. The generalized multilevel Poisson regression model was used to estimate the determinants of ANC utilization by residence. Results showed that women with primary education, from richer households, and with media exposure (individual and community levels), are associated with more ANC services utilization among women in rural but not in urban areas. Women from the community with high poverty levels were associated with lower ANC utilization among women in rural but not in urban areas. Also, our results highlight that women’s media exposure (individual and community levels), and those who participate in decision making were associated with more utilization of ANC services in all other zones but not in the southern, eastern, and Zanzibar zones. The evident differences in the determinants of ANC utilization call for policies and interventions that are group and context-specific to address the existing inequality in the utilization of ANC care services.