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1.BACKGROUND
was estimated in 2005 that of more than 500 000 maternal deaths worldwide, more than half occurred in sub Saharan Africa. The same source estimates life time risk of maternal death to be 1 in 16 in sub-Saharan Africa, as compared to 1 in 2800 in developed regions. The most recent estimates coming from Tanzania show that 94% of pregnant women make at least one antenatal care visit, while only 62% make four or more visits. Women are supposed to be educated and counseled regarding pregnancy-related danger signs during these visits, and that a delivery plan will be created so that readiness for emergency can be better assured. Counseling on pregnancy danger signs is to be conducted according to focused antenatal care (FANC) guidelines, which include signs such as vaginal bleeding, severe headache or blurred vision, severe abdominal pain, swollen hands and face, fever, baby stopped or reduced movement, excessive tiredness/breathlessness(Pembe et al., 2014).
There is evidence that proper antenatal care (ANC) prevents maternal mortality. However, the potential of antenatal care for reducing maternal morbidity and improving newborn survival and health has been widely acknowledged. The antenatal period provides excellent opportunities to reach pregnant women with prophylactic medications, vaccinations, diagnosis and treatment of infectious diseases, as well as with health education programs about development and care of pregnancy. Provision of advice during antenatal care about potential pregnancy complications and danger signs, and information on how to seek medical care, are viewed as key strategies to delay seek for skilled care(Access, 2014).

In Tanzania, the Ministry of Health, Community Development, Gender, Elderly and Children implemented the FANC policy in 2002 and used it for cascading health worker training on a central, regional and district level. The FANC model emphasizes goal oriented and women-centered care by skilled providers. Activities of the new model include the early detection of danger signs and referral; therapeutic interventions known to be beneficial; and alerting pregnant women to emergencies and instructing them on appropriate responses. In fact, one of the main goals of the new model is to strengthen the information component through individual health education and counseling(Access, 2014)
However, the quality of assessment of antenatal care services in Tanzania given to pregnant women are satisfactory since covers most women complications and danger signs of care. The question raise about how the pregnant women have attitudes and knowledge to seek for proper antenatal care as proposed by Ministry of health Community Development Gender Elderly and Children with Focused Antenatal Care (FANC), and practice proper and healthily prenatal care to prevent complications, mortality and morbidity rate in Tanzania. The aim of this study to assess pregnant women’s knowledge, attitudes and practices toward healthily antenatal care in their homes, communities and hospital settings based on focused antenatal care based on women-centered and men involvement during care(Access, 2014).
1.1 PROBLEM STATEMENT
Antenatal care with family planning, skilled delivery care and obstetric cares are key element of package of services aim at improving maternal and neonates’ health. These services involve individualized knowledge and understanding among pregnant women toward caring health of themselves as well as the fetus development during pregnancy period(Were et al., 2013).
Proper health provision including self-awareness to pregnant women aim to reduce death of maternal and neonates during and after delivery, the WHO goals is to reduce maternal mortality rate (MMR) this due to high maternal mortality rate average of 500 per 100000 live births(WHO,2015). This reduction of MMR need collaborative visions and practices between government, health care providers, adult pregnant women and other community members to ensure proper health services to all bearing and pregnant women(Pembe et al., 2014).
Knowledge, attitudes and practices of proper antenatal care among most pregnant is low due to fact that most do not attend all antenatal visits. This affect health of both mother and fetus during pregnant period and hence maternal education should be provided to pregnant women, men and the whole communities about care of pregnancies. This study aiming at assessing the knowledge and practices of pregnant women in their communities and after hospital visits(Mannava, Durrant, Fisher, Chersich, & Luchters, 2015).
1.2 BROAD OBJECTIVE.
To ensure pregnant women understand and practice health methods of prenatal cares at their homes and communities to reduce complications, mortality and morbidity during pregnancy and delivery at Temeke antenatal clinics at Temeke referral hospital from July 2018 to September 2018
1.3 SPECIFIC OBJECTIVES
a) To assess how pregnant women understand about proper and healthily antenatal care during pregnancy visits at Temeke antenatal clinic.
b) Assessing pregnant women’s attitudes toward healthily prenatal practices during pregnancy at home, hospital and communities attending Temeke RCH from July 2018 to September 2018
c) Describe best prenatal practices to pregnant women at Temeke antenatal clinic by increasing their understanding toward pregnancy care.
1.4 SPECIFIC RESARCH QUESTIONS
a) What are percentages of adolescences and adult pregnant women are knowledgeable about healthily antenatal care practices during pregnancy?
b) How pregnant women understand about complications and danger signs happening during pregnancy?
1.5 HYPOTHESIS
Pregnant women who attend at least four antenatal care visits are more likely to have knowledge about pregnant danger signs and complications also practices of pregnancy care to reduce mortality and morbidity during delivery.

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1.6 CONCEPTUAL FRAMEWORK
Fig 1. Conceptual framework of methods for proper antenatal care, knowledge and practices toward health mothers and development of fetus

CHAPTER TWO LITERATURE REVIEW
Antenatal care is highly regarded in both communities, the quality of antenatal services is considered to be good and most women feel obligated to attend. Regular ANC attendance is believed to guarantee healthier pregnancies and uneventful deliveries, and women who miss visits are considered at risk of poor pregnancy outcomes. Also pregnant women attendance to antenatal clinics is influenced by individualized and self-awareness among pregnant women toward important of visiting clinics to know their health and development of baby(Mannava et al., 2015).
Pregnant women attend antenatal clinics due to norms and rituals than awareness about the health
benefit of prenatal care; and that they delayed or not get ANC initiation due to late perception of pregnancy, perceived bad quality of care and lack of social and economic support cause women not to receive enough prenatal care during pregnancy. This findings aim to call for combined interventions from family, community and health system level toward provision of proper antenatal care. Promotion of early and frequent ANC utilization through individual and community based interventions – involving also male partners and women toward increasing their awareness of healthily pregnancy care by supporting, engaging and practicing all antenatal needs for health of mother and baby.
Supporting income generating activities for women such as revolving funds might complement the approach in order to reduce delay due to lack of economic means needed for ANC or other maternal health services. At the same time, the quality of antenatal care services needs to be improved to attract women to use medical care throughout pregnancy, birth and the postpartum period; outreach services should be offered on a regular basis in order to bring services closer to women living in very distant settlements; and informal rules created by health workers in order to force women to attend the ANC clinic should be replaced with informing women about the benefits of maternal health services, but also the use of pregnancy test(Gross, Alba, Glass, Schellenberg, ; Obrist, 2015).
The study suggest that during provision and receiving antenatal care need individualized awareness and knowledge among bearing women, this aim to create strong self-awareness of development of pregnancy, occurrence of danger signs during pregnancy, attending at least four antenatal visits, developing individualized birth preparedness plans and complications readiness so as to reduce Maternal Mortality Rate in Tanzania. In rural area there are more challenges in seeking for antenatal care, delivery and proper postnatal care due to poor health services, low health care providers, transport system challenges and self-awareness among rural pregnant women who most attend few visits and depend on traditional midwifery during delivery. The situation may be is different from urban areas where social services are well improved but there are challenges in understanding and practicing proper and healthily antenatal care services lead into poor development of fetus and mother as well as increase in maternal mortality rate in Tanzania(Gupta, Yamada, Mpembeni, Frumence, ; Callaghan-koru, 2015).

REFERENCE:
Access, O. (2014). Antenatal care in practice?: an exploratory study in antenatal care clinics in the Kilombero Valley , 1–11.
Gross, K., Alba, S., Glass, T. R., Schellenberg, J. A., ; Obrist, B. (2015). Timing of antenatal care for adolescent and adult pregnant women in south-eastern Tanzania.
Gupta, S., Yamada, G., Mpembeni, R., Frumence, G., ; Callaghan-koru, J. A. (2015). Factors Associated with Four or More Antenatal Care Visits and Its Decline among Pregnant Women in Tanzania between 1999 and 2010, 9(7). https://doi.org/10.1371/journal.pone.0101893
Mannava, P., Durrant, K., Fisher, J., Chersich, M., ; Luchters, S. (2015). Attitudes and behaviours of maternal health care providers in interactions with clients?: a systematic review. Globalization and Health, 1–17. https://doi.org/10.1186/s12992-015-0117-9
Pembe, A. B., Carlstedt, A., Urassa, D. P., Lindmark, G., Nyström, L., ; Darj, E. (2014). Quality of antenatal care in rural Tanzania?: counselling on pregnancy danger signs.
Were, F., Afrah, N. A., Chatio, S., Manda-, L., Pell, C., Men, A., … Pool, R. (2013). Factors Affecting Antenatal Care Attendance?: Results from Qualitative Studies in Ghana , Kenya and Malawi, 8(1). https://doi.org/10.1371/journal.pone.0053747