Abstract
<title>Abstract</title> <p>Introduction: Accurate gestational age (GA) documentation is essential for quality antenatal care (ANC), yet paper-based systems in low-resource settings are often affected by incomplete, illegible, and inconsistent records. In Tanzania, these challenges limit continuity of care, maternal vaccination scheduling, and health system decision-making. Digital health innovations, including DHIS2 Tracker-based tools, offer potential to improve data quality and strengthen routine ANC documentation. Methods: A retrospective–prospective assessment study was conducted in five health facilities in Kilimanjaro Region, Tanzania. Retrospective ANC records (2019–2022; N = 81,843) were extracted from paper registers to assess GA documentation and trends over time. Additionally, a DHIS2 Tracker-based electronic tool (E-tool) was implemented prospectively among 200 pregnant women. Data quality indicators included completeness of GA recording, visit-date documentation, legibility, and missing data. Descriptive statistics and percentage-point differences were used to compare paper-based and electronic records. Results: Retrospective analysis showed increasing missing GA records in urban facilities, rising from 15.3% in 2019 to 41.7% in 2022, while rural facilities showed lower and declining gaps. Paper-based GA completeness was 82.8%. Following E-tool implementation, GA completeness improved to 96.0%, visit-date documentation increased from 68.0% to 100%, and record legibility improved from 74.0% to 100%, with overall improvements ranging from + 13.2 to + 32.0 percentage points. Conclusion: The DHIS2 Tracker-based E-tool significantly improved completeness, accuracy, and readability of ANC documentation compared with paper-based systems. Scaling up digital ANC tools could strengthen maternal health information systems and improve continuity of care in resource-limited settings</p>