Abstract

Background Skilled birth attendants (SBAs) are vital for reducing maternal and newborn morbidity and mortality, yet their use remains below national and global targets, particularly in low—and middle-income countries like Tanzania. This study aimed to assess trends and determinants of SBA use among women of reproductive age (WRA) in Tanzania.

Methods This was an analytical cross-sectional study among WRA in Tanzania, using data from the current Demographic and Health Surveys (DHS) 2004/05, 2010, 2015/16, and 2022. Data analysis was performed using STATA version 18. Analysis considered the complex survey design through the application of weights, clustering, and strata. Modified Poisson regression models estimated the determinants associated with SBA use among WRA. Results were presented using adjusted prevalence ratio (APR) with a 95% confidence interval.

Results The study found an increased proportion of SBA use among WRA trends from 57.24% (2004/05) to 84.76% (2022), with the Dar es Salaam region showing higher SBA use of 86.6% in 2022. Residence (APR=0.96, 95% CI: 0.94, 0.99), education (APR=1.10, 95%CI: 1.04, 1.15), wealth index (APR= 1.07, 95% CI:1.02, 1.13), birth order (APR=0.91, 95% CI: 0.88, 0.93), distance to health facility (APR= 1.08, 95% CI: 1.05, 1.12), ANC visits (APR=1.13, 95% CI: 1.08, 1.17), and partners education (APR=1.15, 95% CI: 1.07, 1.23) were the determinants found significantly associated with SBA use.

Conclusion Although SBA use has increased, national and global targets like 90% coverage by 2025 remain unmet. Efforts must focus on improving access, education, and male involvement, especially in rural areas. A comprehensive approach addressing both structural and cultural barriers is essential to ensure skilled care for all women during childbirth.

Competing Interest Statement

The authors have declared no competing interest.

Funding Statement

The author(s) received no specific funding for this work.

Author Declarations

I confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained.

Yes

The details of the IRB/oversight body that provided approval or exemption for the research described are given below:

Permission to access and utilize the data via the DHS Program/ICF International website (http://www.dhsprogram.com) was granted. The data were only used for this study.

I confirm that all necessary patient/participant consent has been obtained and the appropriate institutional forms have been archived, and that any patient/participant/sample identifiers included were not known to anyone (e.g., hospital staff, patients or participants themselves) outside the research group so cannot be used to identify individuals.

Yes

I understand that all clinical trials and any other prospective interventional studies must be registered with an ICMJE-approved registry, such as ClinicalTrials.gov. I confirm that any such study reported in the manuscript has been registered and the trial registration ID is provided (note: if posting a prospective study registered retrospectively, please provide a statement in the trial ID field explaining why the study was not registered in advance).

Yes

I have followed all appropriate research reporting guidelines, such as any relevant EQUATOR Network research reporting checklist(s) and other pertinent material, if applicable.

Yes

Data Availability

The data underlying the results presented in the study are available from http://www.dhsprogram.com

http://www.dhsprogram.com

AbbreviationsAICAkaike InformationBICBayesian Information CriteriaCIConfidence IntervalDHSDemographic and Health SurveyEAEnumeration AreaLMICslow- and lower-middle-income countriesMMRMaternal Mortality RateNBSNational Bureau of StatisticsPRPrevalence RatioPSUPrimary Sampling UnitWRAWomen of Reproductive AgeSBASkilled Birth AttendantsTDHSTanzania Demographic and Health Survey