Using social ecological model to assess the determinants of health facility birth preparedness practices among Indigenous Maasai women in Northern Tanzania.

BACKGROUND: Effective Birth preparedness remain one of the most important intervention to reduce the risk of complications such as postpartum hemorrhage, obstructed labor, fetal distress, uterine rupture, pre-eclampsia, eclampsia, infections, still birth and unsafe abortion. Despite the efforts to encourage women to give birth in healthcare facilities, improvement has remained stagnant, particularly in remote Indigenous Maasai population in northern Tanzania. This study utilizes the Social Ecological Model (SEM) as a guiding framework to assess the multilevel determinants influencing health facility birth preparedness practices among Indigenous Maasai women. The study explores how individual, interpersonal, community, and societal-level factors influence maternal health behaviors. METHODOLOGY: The study employed a community-based analytical cross-sectional study design, which was conducted among 355 Indigenous Maasai women who had given birth within the last 24 months, from 11th April 2024 to 30th June 2024. The study employed a multistage sampling technique to select the study participants. A structured questionnaire adapted from previous studies was used to collect data. The univariate and multivariate binary logistic regression model was used to analyze determinants of birth preparedness practices, and the statistical significance was declared at 95% CI, and p < 0.05. RESULTS: The mean age of study participants was 29.6 years ± 7.4 (SD), only 10.14% of the participants were prepared for health facility birth. The determinants influencing health facility birth preparedness practices included higher average monthly income (AOR = 11.702, 95% CI: 1.306, 104.835, p = 0.028), adequate knowledge of obstetric danger signs (AOR = 85.273, 95% CI: 2.282, 3186.398, p = 0.016), availability of drugs and supplies (AOR = 5.901, 95% CI: 1.013, 34.385, p = 0.048), accessible roads throughout the year (AOR = 8.602, 95% CI: 1.420, 52.107, p = 0.019), and perceived quality of services at health facility (AOR = 21.661, 95% CI: 2.212, 212.072, p = 0.008). CONCLUSION: This study reveals low health facility birth preparedness among Indigenous Maasai women, influenced by socioeconomic challenges, limited knowledge, and poor infrastructure. To address this, multifaceted interventions are needed to improve financial access, education, and healthcare quality. A sustainable approach requires collaboration between the health sector, local government, and community leaders. Ensuring equity in maternal healthcare is crucial, particularly for marginalized indigenous populations. Addressing systemic barriers like poor road infrastructure is essential to improving access. These strategies are vital for better birth preparedness and maternal health outcomes in the region.