TABLE 4.

Unadjusted and Adjusted Statistical Associations of Individual and Community Characteristics and PNC Use in Kigoma Region Tanzania Based on 3 Random Intercept Models

	Unadjusted			Model 1 Individual Characteristics			Model 2 Community Characteristics			Model 3 Individual and Community
Individual Characteristic	OR	95% CI	P Value	aOR	95% CI	P Value	aOR	95% CI	P Value	aOR	95% CI	P Value
Maternal age at birth, years
Under 25	1.00 (ref)			1.00 (ref)						1.00 (ref)
25–34	0.90	0.74–1.09	.2074	0.92	0.72–1.18	.4896				0.91	0.71–1.17	.4727
35–49	1.02	0.88–1.30	.5028	1.02	0.67–1.57	.9234				1.01	0.65–1.56	.981
Literacy
No	1.00 (ref)			1.00 (ref)						1.00 (ref)
Yes	1.05	0.85–1.25	.613	0.84	0.68–1.04	.1027				0.83	0.67–1.02	.0767
Work status
Does not work outside home	1.00 (ref)			1.00 (ref)						1.00 (ref)
Works outside home	1.22	0.91–1.63	.1760	1.02	0.75–1.40	.8992				0.99	0.73–1.35	.9456
Wealth tercile
Low	1.00 (ref)			1.00 (ref)						1.00 (ref)
Middle/high	1.34	1.05–1.72	.0207^a	1.25	1.00–1.59	.0628				1.25	0.99–1.59	.0705
Current marital status
Married	1.33	1.03–1.76	.0472^a	1.05	0.78–1.41	.7436				1.07	0.80–1.45	.6709
Not married	1.00 (ref)			1.00 (ref)						1.00 (ref)
Decision-making index
Low/medium	1.00 (ref)			1.00 (ref)						1.00 (ref)
High	1.65	1.29–2.12	.0001^a	1.57	1.12–2.19	.0093^a				1.56	1.11–2.17	.011^a
Parity
1 child	1.00 (ref)			1.00 (ref)						1.00 (ref)
2–4 children	1.01	0.69–1.47	.59	1.00	0.72–1.40	.9865				1.01	0.72–1.42	.9297
5 or more children	0.86	0.66–1.13	.1473	0.92	0.60–1.43	.725				0.95	0.61–1.48	.8302
ANC utilization
0–3 visits	1.00 (ref)			1.00 (ref)						1.00 (ref)
4 or more visits	0.90	0.73–1.11	.328	0.84	0.68–1.04	.124				0.85	0.68–1.05	.1364
Counseled for birth plan
No	1.00 (ref)			1.00 (ref)						1.00 (ref)
Yes	1.46	1.09–2.00	.0114^a	1.47	1.00–2.19	.0629				1.40	0.93–2.12	.1089
Place of delivery and its adequacy^b
Home/on the way	1.00 (ref)			1.00 (ref)						1.00 (ref)
Dispensary, any readiness	1.94	1.24–3.01	.169	0.86	0.37–2.00	.7315				0.79	0.34–1.86	.5969
Hospital/HC with less than adequate readiness	1.61	1.02–2.55	.7793	0.98	0.41–2.36	.9761				0.87	0.36–2.09	.8869
Hospital/HC with adequate readiness	2.48	1.62–3.81	.0003^a	1.17	0.51–2.66	.7161				1.06	0.46–2.48	.7509
Mode of delivery
Normal vaginal	1.00 (ref)			1.00 (ref)						1.00 (ref)
Cesarean	2.88	1.95–4.27	<.0001^a	2.29	1.50–3.49	.0002^a				2.27	1.47–3.48	.0002^a
Companionship at birth
No companion during labor or delivery	1.00 (ref)			1.00 (ref)						1.00 (ref)
Companion during labor or delivery	1.46	1.12–1.91	.0059^a	1.54	1.16–2.04	.0024^a				1.57	1.19–2.07	.0013^a
Pregnancy intendedness
Intended	1.16	0.91–1.47	.2463	1.11	0.87–1.42	.4081				1.11	0.87–1.42	.4086
Unintended	1.00 (ref)			1.00 (ref)						1.00 (ref)
Birth outcome
Live birth	0.82	0.38–1.78	.6074	1.13	0.57–2.24	.7199				1.04	0.53–2.06	.9057
Stillbirth	1.00 (ref)			1.00 (ref)						1.00 (ref)
Postpartum complications
Absent	1.00 (ref)			1.00 (ref)						1.00 (ref)
Present	0.82	0.64–1.06	.1342	0.85	0.64–1.14	.2755				0.89	0.66–1.19	.4184
Satisfaction with delivery services
Not satisfied/did not deliver in facility	1.00 (ref)			1.00 (ref)						1.00 (ref)
Satisfied/somewhat satisfied	2.00	1.39–2.87	.0002^a	1.32	0.64–2.71	.4519				1.33	0.64–2.71	.4493
Frequency of radio listening
Never	1.00 (ref)			1.00 (ref)						1.00 (ref)
Sometimes	1.21	0.96–1.54	.1128	1.09	0.87–1.37	.4457				1.06	0.84–1.32	.6263
Community Characteristic
Area of residence
Rural	1.00 (ref)						1.00 (ref)			1.00 (ref)
Urban	1.79	1.15–2.79	.0099^a				1.51	0.78–2.96	.2233	1.34	0.67–2.76	.4156
Community socioeconomic status
Low	1.00 (ref)						1.00 (ref)			1.00 (ref)
Middle	0.92	0.54–1.58	.769				1.03	0.60–1.77	.90	0.87	0.49–1.53	.6294
High	1.31	0.81–2.12	0.276				0.79	0.47–1.36	.4102	0.71	0.41–1.23	.2163
District
Kigoma Rural	1.00 (ref)						1.00 (ref)			1.00 (ref)
Kigoma Urban	3.61	2.00–6.51	<.0001^a				0.80	0.30–2.12	.657	0.88	0.32–2.44	.8148
Kibondo	2.94	1.66–5.24	.0002^a				2.03	1.03–4.01	.0407^b	1.80	0.88–3.67	.1096
Kasulu	3.68	2.38–5.70	<.0001^a				3.15	1.92–5.17	<.0001^c	3.28	1.94–5.52	<.0001^a
Distance to nearest facility with maternity care^c
0–5 km	3.48	1.38–8.69	.0080^a				2.01	0.97–4.17	.0598^a	1.95	0.92–4.16	.0868
5.1–10 km	2.72	0.83–8.94	.0988				2.06	0.89–4.80	.0936^a	2.13	0.90–5.05	.0876
More than 10 km	1.00 (ref)						1.00 (ref)			1.00 (ref)
Adequate facility ^b^,c within 5 km
Absent	1.00 (ref)						1.00 (ref)			1.00 (ref)
Present	2.31	1.53–3.49	<.0001^a				2.44	1.37–4.37	.0026^c	2.15	1.06–3.88	.032^a
Adequate facility ^b^,c within 5–10 km
Absent	1.00 (ref)						1.00 (ref)			1.00 (ref)
Present	1.30	0.82–2.06	.2698				0.98	0.57–1.69	.9496	1.04	0.59–1.81	.8878
Community perception that quality of care at nearest health facility is poor^d
Low	1.00 (ref)						1.00 (ref)			1.00 (ref)
Middle	1.05	0.67–1.65	.8365				1.16	0.76–1.78	.4915	0.94	0.57–1.56	.3356
High	0.52	0.31–0.87	.0128^a				0.88	0.53–1.45	.604	1.24	0.80–1.91	.818
Community perception that it is very important to deliver in a health facility^d
Low	1.00 (ref)						1.00 (ref)			1.00 (ref)
Middle	1.82	1.08–3.08	.0252^a				1.26	0.77–2.06	.3528	1.26	0.74–2.16	.3935
High	1.93	1.13–3.31	.0169^a				1.24	0.74–2.08	.4058	1.25	0.75–2.07	.3919
Variance (SE)				1.24 (0.21)			0.85 (0.16)			0.91 (0.17)
ICC				27%			21%			22%

Abbreviations: aOR, adjusted odds ratio; ANC, antenatal care; AVD, assisted vaginal delivery; CI, confidence interval; ICC, intraclass correlation coefficient; OR, odds ratio; PNC, postnatal care; ref., reference group; SE, standard error.
↵a Significant at P value <.05.
↵b Facility adequacy was estimated using the World Health Organization guidelines of assessing facility readiness for routine maternity care.³⁴ Each facility was assessed based on presence or absence of 30 attributes necessary for performing routine maternity services. We created an index score ranging from 0 to 30 based on the presence of each attribute. Facilities that had a score in the highest decile (i.e., having 28 or more attributes) were classified as having adequate readiness for routine maternal care services. The other facilities were classified as having less than adequate readiness. There were 68 women who delivered in the region in small-volume dispensaries that were not included in the health facility assessment. Their delivery facilities were classified as having less than adequate readiness based on inputs from health managers in the region.
↵c Distance estimated using ArcGIS models for travelling by roads or paths accessible to walking.
↵d Created by aggregating dichotomized individual level responses in each community and categorizing the resulting aggregate variables as terciles (low [0%–32.9%], middle [33.0%–65.9%], and high [≥66%]).