Antenatal care especially when thought early allows regular checkups for the health of the pregnant woman and early interventions incase of any complications. Findings of this study show that almost all women (99%) sought antenatal care at least once during their last pregnancy. These findings compare well with those of the Tanzania Demographic and Health Surveys [8
]. Main reasons reported earlier for this universal ANC attendance included seeking for immunizations for tetanus, prophylaxis for anaemia and malaria and the fact that women want to be assured that their unborn babies are well [12
]. Majority of women delayed their first ANC visit and about a third went for fewer than recommended number of visits. Late start of ANC and too few visits reduces the effectiveness of the ANC as some necessary interventions are started either very late in pregnancy or they are not completed before the time of delivery. These results also agree with a study conducted in Nigeria, where the median time for first ANC visit was found to be 23.7 weeks [14
]. Women book late to avoid going for many ANC visits particularly in circumstances where the facility is quite far and there are no reliable means of transport.
Proportion of women who delivered in the health facility was only 46.7% where as the proportion who had skilled assistance was 44.5%. These estimate compares well with the national level rates (47% Vs 46%) observed in the most recent demographic and Health survey but higher compared to the rates obtained from the study region (37%) in the same survey [8
]. The low coverage rate in the TDHS sample in this region may be the cause of these discrepancies. Low rates of health facility deliveries in developing countries have been reported by several other researchers [15
]. Fear of being referred to hospital, availability of TBA's, emergency nature of labour were mentioned to be the major causes of home deliveries. This low utilization of skilled attendants at delivery represents the great challenge to achieve the MDG's in the next nine years.
A number of socio demographic and economic factors were found to have a significant influence on use of skilled care at delivery. They include women's age, education level, and marital status. Younger women are just starting child bearing and are told to be in a high risk group and so they tend to fear home deliveries. It is also possible that the new generation with a higher proportion of women who have formal education have different perspectives on delivery care when compared to the older generations. These variables also influence the status of the woman in the society which has been found to influence decision making. A woman who is educated, single and of higher socio economic status is able to make wise decisions about her own health than their counterparts. Similar findings were reported by previous researchers [16
]. It has been reported that both economic and social dimensions of the distribution of power between spouses influence the use of services [23
Women who were knowledgeable of risk factors were more likely to utilize health facilities for delivery compared to those with no knowledge. Similar findings were reported in Malawi and in Zambia [18
]. It is expected that a better informed individual is better placed to make reasonable decisions.
Distance to the health facility was a significant determinant of type of delivery care. This was said to be made worse by the fact that there are no means of transport to the facility. Similar findings were reported by a number of researchers previously [16
Women who had more than 4 ANC visits were more likely to deliver with a skilled attendant than those with fewer visits. Similar findings were reported in Cambodia [16
]. This may be due to the fact that women with more ANC visits also showed a higher satisfaction with the care quality and hence more likely to use health services for delivery. It is also a fact that many ANC visits expose the women to more health education and counseling which are both likely to increase service utilization. This finding lead previously to a recommendation that although antenatal care may not be efficient in identifying women who are most in need of obstetric care, if promoted it may become an effective instrument to facilitate better use of emergency obstetric care services [26
Surprisingly women who reported illnesses/pregnancy complications during pregnancy did not have an increased chance to use health facilities. This may be due to wrong perceptions of causation which lead them to seek care from traditional healers instead of modern health facilities.
In contrast to findings of several other studies, perceived quality of ANC care was not seen to influence the choice of a delivery attendant. This may be due to the fact that majority (85%) of women in this study perceived the ANC care quality as good.