1. of the problem, objectives of the study,

1. Introduction
This section of the research consists of the first chapter contents like the background of the study, statements of the problem, objectives of the study, basic research questions, significance of the study, scope and limitations of the study and the organization of the study.
1.1. Background of the study
Today, tourism is widely recognized as the largest industry on earth based on its contribution to global gross domestic product, the number of jobs it generates, and the number of clients it serves. Tourism is one of the top five exports for 83 percent of all countries and the number one source of foreign exchange for 40 percent of countries (UNWTO, 2006). By 1990, there were 450 million annual tourism arrivals globally, and 2006 saw an all-time record of 842 million tourists – an increase of more than 3,000 percent over 1950. The UNWTO forecasts that over the coming 15 years, the number of tourists will rise to 1.5 billion, twice the current total. In 2007, tourism is expected to generate more than $7 trillion in economic activity worldwide, up 5.7 percent. In terms of job creation, travel and tourism employment is expected to reach 231.2 million jobs in 2007, representing 8.3 percent of total employment worldwide, or 1 in every 12 jobs on the planet (UNWTO, 2006). The tourism sector is growing fast and stands as the third foreign exchange earner, following coffee and oilseeds (Mann, 2010). Many factors are contributing to such positive achievement. Ethiopian Air Lines provides international flights and connections to most parts of the world. Ethiopia is reasonably well connected by international flights and Ethiopian Air Lines has one of the best reputations amongst African national airlines (UNWTO, 2006).
As cited by Ministry of Culture and Tourism (2009) UNWTO’s current analysis of
tourist arrivals puts Ethiopia’s average annual growth in international tourist arrivals
at 5.6 percent for the period 1990-2000, and at 15.4 percent during the period 2000-
2008. The average growth rates achieved during the more recent years represent an
encouraging trend indeed. Taking this into account, for instance, Ethiopia’s share of
the tourist flow to the East African Region of seventeen countries in 2007 was 0.7
percent. Despite its numerous historical, cultural, and natural attractions, the country’s
tourist flow shows that the very low stage of development (World Bank, 2007). In the
same way, although the share of the tourism sector for the region’s GDP is increasing
from time to time and it has been played a pivotal role in the creation of employment
opportunities, its contribution is still less as compared to the region’s potential tourist
attraction resources. There are various factors that have been hindering the tourism
development in one or another way. Some of the factors that affect the tourist
satisfaction in SNNPR are; the attractions have not been adequately protected, developed and used as tourist attraction. There is a serious shortage in number and
type of tourist facilities at existing and potential tourist destinations and vicinities;
moreover, the quality of service is unsatisfactory to tourists. In addition
interpretations of tourist attractions are not based on credible facts and knowledge;
they are not consistent; and their presentation is disorganized. Handicrafts, other local
creative products, performing arts and entertainment services, which could have
helped to lengthen the stay and increase the duration of visitors at every destination,
are not offered in sufficient variety, quantity, and quality. The major goal of promotion in the tourism industry is to attract as many tourists as possible. In order to increase the number of visitors, it is essential to meet consumers’ expectation levels (MoCT, 2013).
Tourism competitiveness for a destination is about the ability of the place to optimize its attractiveness for residents and non-residents, to deliver quality, innovative, and attractive (e.g. providing good value for money) tourism services to consumers and to gain market shares on the domestic and global market places, while ensuring that the available resources supporting tourism are used efficiently and in a sustainable way. Tourism is recognized as one of the key sectors of development in all countries and a major source of income, jobs and wealth creation. It also plays a wider role in promoting the image and international perception of a country externally as well as influencing complementary domestic policies. This range of influence and importance creates challenges in measuring competitiveness in tourism. Understanding country competitiveness in tourism is a major consideration for policy makers and a major challenge for professionals in providing evidence to inform decision making.
Various indicators have been developed by different organizations over the years to address particular aspects of competitiveness but there has remained a lack of an overall measurement framework for competitiveness in tourism for the use of governments. The current work by member and partner countries seeks to address this gap and make a positive contribution to the practical measurement of competitiveness.
The influences on competitiveness can change quickly and this dynamic creates further challenges and a need for on-going research and development on indicators. Global economic and tourism trends, including changing market trends and travel behaviors, the role of social media and new sources of demand and growth increase the importance of the topic and the ability of partner countries to compete within the changing global marketplace (Alain Dupeyras, Neil MacCallum 2009)
Visitors have to consider a destination to be attractive and worth the investment of time and money to visit. As such, we can think of destination as cultural appraisals. It is therefore, vital to maintain the difference between the destination in the home environment through good design and management, and therefore to avoid the development of uniform tourism landscapes. The multiple use of destinations means it is possible to classify enterprises according to whether they depend upon tourism only, residents only, or a mix of the two (Cooper et al. 1993).
Cooper et al. (1993) observe that as destinations are an amalgam, there are a number of important implications which are common across all destinations.
Researchers have endeavored to reveal those factors that consumers consider important, and the processes undertaken when choosing a destination amongst a group of like alternatives (Chon 1990, Woodside ; Lysonski 1989, Gunn 1989). Furthermore, studies have begun to investigate satisfaction levels relating to the quality of the destination experience (Moyle ; Croy 009; Yoon ; Uysal 2005; Kozak ; Rimmington 2000; Baker ; Crompton 2000). Such studies aim to better enable destination management organizations to implement strategies aimed at enhancing destination competitiveness.

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

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).

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


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