Study design and data
This study is a cross-sectional analysis of a dataset from the 2015-16 Tanzania Demographic and Health Survey and Malaria Indicator Survey (2015-16 TDHS-MIS).
The 2015-16 TDHS-MIS
This section of the method has been published previously in the report of “Tanzania Demographic and Health Survey and Malaria Indicator Survey 2015-16” .
The 2015-16 TDHS-MIS is the ninth in a series of national sample surveys conducted in Tanzania to measure levels, patterns, and trends in demographic and health indicators. The survey was undertaken by the National Bureau of Statistics (NBS) and the Office of Chief Government Statistician (OCGS), Zanzibar, in collaboration with the Ministry of Health, Community Development, Gender, Elderly, and Children on the Tanzania Mainland and the Ministry of Health, Zanzibar. The primary objective of the 2015-16 TDHS-MIS was to provide up-to-date estimates of basic demographic and health indicators. The survey collected information on fertility levels, marriage, sexual activity, fertility preferences, awareness and use of family planning methods, breastfeeding practices, nutrition, childhood and maternal mortality, maternal and child health, malaria, and other health-related issues.
The sample design for the 2015-16 TDHS-MIS was done in two stages and was intended to provide
estimates for the entire country, for urban and rural areas in Tanzania Mainland, and for Zanzibar. The first stage involved selecting sample points (clusters), consisting of enumeration areas (EAs) delineated for the 2012 Tanzania Population and Housing Census. A total of 608 clusters were selected. In the second stage, a systematic selection of households was involved. A complete households listing was carried out for all 608 selected clusters prior to the fieldwork. From the list, 22 households were then systematically selected from each cluster, yielding a representative probability sample of 13,360 households for the 2015-16 TDHS-MIS. All women age 15-49 who were either usual residents or visitors in the household on the night before the survey were included in the 2015-16 TDHS-MIS and were eligible to be interviewed. Out of a total of 13,360 households selected for the 2015-16 TDHS, 12,767 were occupied. Of the occupied households, 12,563 were successfully interviewed, yielding a response rate of 98%. In the interviewed households, 13,634 eligible women were identified for individual interviews; interviews were completed with 13,266 women, yielding a response rate of 97%.
Four questionnaires based on the DHS program’s standard were used for the 2015-16 TDHS-MIS: The Household Questionnaire, the Woman’s Questionnaire, the Man’s Questionnaire, and the Biomarker Questionnaire. In particular, the Woman’s Questionnaire was used to collect information from all eligible women age 15-49. The information collected includes background characteristics, birth history and childhood mortality, knowledge and use of family planning methods, fertility preferences, antenatal, delivery, and postnatal care, breastfeeding and infant feeding practices, vaccinations and childhood illnesses, marriage and sexual activity, women’s work and husbands’ background characteristics, adult mortality, including maternal mortality, malaria, domestic violence, and other health issues
Study population and data extraction
For the present analysis, a subset of the original TDHS-MIS dataset was abstracted using the following criteria: women of reproductive age (15-49 years) who gave birth within the year preceding the survey. The individual recodes (TZIR7BFL) file was used. The final sample size for this analysis resulted into 2,286 women. We then dropped unnecessary variables to this study from the data file.
Through a literature review, a conceptual framework was developed to guide the data review. The conceptual framework defined the primary independent variables (socio-demographic and obstetric characteristics of a woman), the intermediate variable (antenatal services utilization, coded 1 for adequate antenatal services utilization [four or more antenatal care visits] and coded 0 for inadequate antenatal services utilization [less than four antenatal care visits]), and the original outcome variable (place of delivery, later dichotomized into a dummy variable coded 1 if a woman delivered outside of a health facility, such as home or TBA premises, and 0 if she delivered at health facility).
Data were analyzed using Statistical Package for Social Sciences (IBM SPSS version 20). Data analysis started by describing all study variables using frequencies and percentages. We then assessed the association between dependent variables and independent variables using the chi-squared test, and finally, we performed binary logistic regression analysis (univariate and multivariate) to determine significant predictors of the choice of place of delivery. All analyses were based on a 5% level of significance.