In the present study, the proportion of women who reported to have taken in the deworming drugs during their pregnancy was 60.1%. This proportion is lower than the proportion of women who attend at least one antenatal visit in Tanzania, which is about 98% . This implies that, a significant proportion of pregnant women attend ANC but do not comply to deworming drugs.
In this study, the factors that directly affect the uptake of deworming drugs include: Early antenatal booking, age group of a woman rural, residence, wealth index, level of education, parity, and the zone of residence.
Women who attend early in the antenatal clinic are more likely to uptake the deworming drugs than those who attend later. Early attendance in the antenatal clinic is related to knowledge regarding the use of deworming drugs , while late initiation of antenatal care (ANC) is associated with poor knowledge .Therefore, those who attend early in the antenatal clinics are more knowledgeable about the importance of up taking the deworming drugs than those who attend late or never. These findings underscore the importance of reproductive health education including uptake of deworming drugs among women of reproductive health even before they become pregnant, and whenever possible, beyond antenatal clinics.
The findings of this study also revealed that, women above 20 years of age were more likely to uptake the deworming drugs than woman below 20 years. Consistent with this, a recent study reveals that the odds of helminthic infection among pregnant women aged below 21 were more than twice as much as those above 21 years . These findings may have multiple explanations: Firstly, unlike women above 20 years of age, most women at the age below 20 in Tanzania are at their secondary and college education. Therefore, the majority are unmarried and have their pregnancies unplanned. While unplanned pregnancy is associated with late initiation of antenatal care , planned pregnancy is associated with early initiation of antenatal services , and health-seeking behavior  which are important factors for the uptake of the deworming drugs.
Secondly, women above 20 years are likely to be multiparous and/or multigravida, while women at the age below 20 in Tanzania are mostly primigravida / primipara . Multiparous women are likely to have had more antenatal attendances in their previous pregnancies. Because antenatal clinics are the main sources of antenatal knowledge among the women in Tanzania, and each time a woman attends, is an opportunity for more education, then the number of pregnancy a woman has ever had is likely to be proportional to the level of knowledge about antenatal services. In the recent study in Sri Lanka, multiparous women(2–4 children) were more knowledgeable about complication readiness in pregnancy than nulliparous women . The level of knowledge is a significant factor for early initiation of ANC and compliance to deworming drugs.
In this study, however, women who are para 5 and above (Grand multipara) were slightly negatively associated with compliance in taking deworming drugs. The reason could be that, the grand multipara women find themselves more experienced to pregnancy and to routine ANC services. This confidence delays their antenatal initiation and impairs compliance in taking deworming drugs. The role of grand multiparity in reducing the odds of ANC attendance is reported in several other studies . These observations warrant a need for a special educational and sensitization program targeting grand multiparas, not only about compliance in taking the deworming drugs but also on the utilization of family planning programs.
The findings of this study reveal that wealthier women are more likely to uptake the deworming drugs than the poor [middle (AOR = 1.151 at 95% CI = 1.003–1.32, p = 0.044), rich (AOR = 1.378 at 95% CI = 1.185–1.602, p < 0.001).This has a dual explanation: First, being wealthier implies that women are, not only able to afford transport to the clinic where they can access the services, but also able to afford the deworming drugs from the pharmaceutical stores when the ANC clinics run out of stock . The influence of wealth on utilization of ANC has been reported in Nigeria , and Ghana . Second, wealthier and employed women are more likely to attend antenatal clinics early than unemployed , which is a significant factor for the uptake of deworming drugs. This accounts for the importance of women’s economic empowerment in improving ANC utilization including uptake of the deworming drugs.
In this study, women with a higher level of formal education were more likely to uptake the deworming drugs than women without formal education (AOR = 2.455 at 95% CI = 1.189–5.067, p = 0.015)]. More intriguingly, recent evidences reveal that, the odds of intestinal parasitic infection among illiterate pregnant mothers is more than 2 folds higher that the educated pregnant mothers .Combining the two observations, it can be suggested that, women with formal education are likely to have knowledge on the importance of hygiene and compliance to deworming drugs during pregnancy, and health-seeking behavior than those without formal education. Besides, formal education by pregnant women is associated with early ANC initiation , an important factor for the compliance to deworming drugs. These findings support the national and international call for women’s educational empowerment, if proper uptake of deworming drugs and other antenatal services are to be achieved.
Regarding the influence of geographical residence on the uptake of deworming drugs, (Table 3), mainland urban areas are associated with higher uptake than the mainland rural areas and in Zanzibar and Pemba islands. This observation correlates with the higher prevalence of helminthiasis in rural areas than urban areas reported in a recent study . Similarly, the lower uptake in Zanzibar and Pemba islands correlates with their corresponding higher prevalence of helminthiasis than in mainland urban . While more exploratory studies are warranted, the differences in uptake may be explained by inadequate campaigns among pregnant women, delayed ANC initiation in rural compared to urban  and the higher illiteracy rate among pregnant women in rural areas .
Strength And Limitation And Strength Of The Study
The strength of this study is that it was community-based which covered participants from all the nine zones of Tanzania. Therefore, the findings may represent the factors associated with uptake of de-worming drugs during pregnancy among women of reproductive age in Tanzania. However, being a retrospective study, it included only women who remembered the timing for antenatal booking of their youngest child, which may lead to recall bias.