41 research outputs found
Maternal health interventions in resource limited countries: a systematic review of packages, impacts and factors for change.
Get PDFThe burden of maternal mortality in resource limited countries is still huge despite being at the top of the global public health agenda for over the last 20 years. We systematically reviewed the impacts of interventions on maternal health and factors for change in these countries. A systematic review was carried out using the guidelines for Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). Articles published in the English language reporting on implementation of interventions, their impacts and underlying factors for maternal health in resource limited countries in the past 23 years were searched from PubMed, Popline, African Index Medicus, internet sources including reproductive health gateway and Google, hand-searching, reference lists and grey literature. Out of a total of 5084 articles resulting from the search only 58 qualified for systematic review. Programs integrating multiple interventions were more likely to have significant positive impacts on maternal outcomes. Training in emergency obstetric care (EmOC), placement of care providers, refurbishment of existing health facility infrastructure and improved supply of drugs, consumables and equipment for obstetric care were the most frequent interventions integrated in 52%-65% of all 54 reviewed programs. Statistically significant reduction of maternal mortality ratio and case fatality rate were reported in 55% and 40% of the programs respectively. Births in EmOC facilities and caesarean section rates increased significantly in 71%-75% of programs using these indicators. Insufficient implementation of evidence-based interventions in resources limited countries was closely linked to a lack of national resources, leadership skills and end-users factors. This article presents a list of evidenced-based packages of interventions for maternal health, their impacts and factors for change in resource limited countries. It indicates that no single magic bullet intervention exists for reduction of maternal mortality and that all interventional programs should be integrated in order to bring significant changes. State leaders and key actors in the health sectors in these countries and the international community are proposed to translate the lessons learnt into actions and intensify efforts in order to achieve the goals set for maternal health
Using audit to enhance quality of maternity care in resource limited countries: lessons learnt from rural Africa.
Get PDFAlthough clinical audit is an important instrument for quality care improvement, the concept has not yet been adequately taken on board in rural settings in most resource limited countries where the problem of maternal mortality is immense. Maternal mortality and morbidity audit was established at Saint Francis Designated District Hospital (SFDDH) in rural Tanzania in order to generate information upon which to base interventions. Methods are informed by the principles of operations research. An audit system was established, all patients fulfilling the inclusion criteria for maternal mortality and severe morbidity were reviewed and selected cases were audited from October 2008 to July 2010. The causes and underlying factors were identified and strategic action plans for improvement were developed and implemented. There were 6572 deliveries and 363 severe maternal morbidities of which 36 women died making institutional case fatality rate of 10%. Of all morbidities 341 (94%) had at least one area of substandard care. Patients, health workers and administration related substandard care factors were identified in 50% - 61% of women with severe morbidities. Improving responsiveness to obstetric emergencies, capacity building of the workforce for health care, referral system improvement and upgrading of health centres located in hard to reach areas to provide comprehensive emergency obstetric care (CEmOC) were proposed and implemented as a result of audit. Our findings indicate that audit can be implemented in rural resource limited settings and suggest that the vast majority of maternal mortalities and severe morbidities can be averted even where resources are limited if strategic interventions are implemented
Bridging the gaps in the Health Management Information System in the context of a changing health sector
Get PDFAbstract Background The Health Management Information System (HMIS) is crucial for evidence-based policy-making, informed decision-making during planning, implementation and evaluation of health programs; and for appropriate use of resources at all levels of the health system. This study explored the gaps and factors influencing HMIS in the context of a changing health sector in Tanzania. Methods A cross sectional descriptive study was conducted in 11 heath facilities in Kilombero district between January and February 2008. A semi-structured questionnaire was used to interview 43 health workers on their knowledge, attitude, practice and factors for change on HMIS and HMIS booklets from these facilities were reviewed for completeness. Results Of all respondents, 81% had never been trained on HMIS, 65% did not properly define this system, 54% didn't know who is supposed to use the information collected and 42% did not use the collected data for planning, budgeting and evaluation of services provision. Although the attitude towards the system was positive among 91%, the reviewed HMIS booklets were never completed in 25% - 55% of the facilities. There were no significant differences in knowledge, attitude and practice on HMIS between clinicians and nurses. The most common type of HMIS booklets which were never filled were those for deliveries (55%). The gaps in the current HMIS were linked to lack of training, inactive supervision, staff workload pressure and the lengthy and laborious nature of the system. Conclusions This research has revealed a state of poor health data collection, lack of informed decision-making at the facility level and the factors for change in the country's HMIS. It suggests need for new innovations including incorporation of HMIS in the ongoing reviews of the curricula for all cadres of health care providers, development of more user-friendly system and use of evidence-based John Kotter's eight-step process for implementing successful changes in this system.</p
Importance of leadership and management to support improved quality in maternal and newborn care
Get PDFEffective leadership and management (L&M) have a wide range of functions in improving quality in maternal and newborn health care. In Tanzania, maternal and perinatal adverse outcomes have been attributed to ineffective L&M (Assisting Safe Deliveries in Tanzania/ASDIT audits). This brief presentation reviews why leadership and management are important attributes of health care delivery in terms of maternal and child health.Global Affairs Canada (GAC)Canadian Institutes for Health Research (CIHR
Tanzanian lessons in using non-physician clinicians to scale up comprehensive emergency obstetric care in remote and rural areas.
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ABSTRACT:\ud
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BACKGROUND\ud
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With 15-30% met need for comprehensive emergency obstetrical care (CEmOC) and a 3% caesarean section rate, Tanzania needs to expand the number of facilities providing these services in more remote areas. Considering severe shortage of human resources for health in the country, currently operating at 32% of the required skilled workforce, an intensive three-month course was developed to train non-physician clinicians for remote health centres.\ud
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METHODS\ud
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Competency-based curricula for assistant medical officers' (AMOs) training in CEmOC, and for nurses, midwives and clinical officers in anaesthesia and operation theatre etiquette were developed and implemented in Ifakara, Tanzania. The required key competencies were identified, taught and objectively assessed. The training involved hands-on sessions, lectures and discussions. Participants were purposely selected in teams from remote health centres where CEmOC services were planned. Monthly supportive supervision after graduation was carried out in the upgraded health centres\ud
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RESULTS\ud
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A total of 43 care providers from 12 health centres located in 11 rural districts in Tanzania and 2 from Somalia were trained from June 2009 to April 2010. Of these 14 were AMOs trained in CEmOC and 31 nurse-midwives and clinical officers trained in anaesthesia. During training, participants performed 278 major obstetric surgeries, 141 manual removal of placenta and evacuation of incomplete and septic abortions, and 1161 anaesthetic procedures under supervision. The first 8 months after introduction of CEmOC services in 3 health centres resulted in 179 caesarean sections, a remarkable increase of institutional deliveries by up to 300%, decreased fresh stillbirth rate (OR: 0.4; 95% CI: 0.1-1.7) and reduced obstetric referrals (OR: 0.2; 95% CI: 0.1-0.4)). There were two maternal deaths, both arriving in a moribund condition.\ud
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CONCLUSIONS\ud
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Tanzanian AMOs, clinical officers, and nurse-midwives can be trained as a team, in a three-month course, to provide effective CEmOC and anaesthesia in remote health centres
The quality of antenatal care in rural Tanzania: what is behind the number of visits?
Get PDFBackground: Antenatal care (ANC) provides an important opportunity for pregnant women with a wide range of interventions and is considered as an important basic component of reproductive health care.Methods: In 2008, severe maternal morbidity audit was established at Saint Francis Designated District Hospital (SFDDH), in Kilombero district in Tanzania, to ascertain substandard care and implement interventions. In addition, a cross-sectional descriptive study was carried out in 11 health facilities within the district to assess the quality of ANC and underlying factors in a broader view.Results: Of 363 severe maternal morbidities audited, only 263 (72%) ANC cards were identified. Additionally, 121 cards (with 299 ANC visits) from 11 facilities were also reviewed. Hemoglobin and urine albumin were assessed in 22% - 37% and blood pressure in 69% - 87% of all visits. Fifty two (20%) severe maternal morbidities were attributed to substandard ANC, of these 39 had severe anemia and eclampsia combined. Substandard ANC was mainly attributed to shortage of staff, equipment and consumables. There was no significant relationship between assessment of essential parameters at first ANC visit and total number of visits made (Spearman correlation coefficient, r = 0.09; p = 0.13). Several interventions were implemented and others were proposed to those in control of the health system.Conclusions: This article reflects a worrisome state of substandard ANC in rural Tanzania resulting from inadequate human workforce and material resources for maternal health, and its adverse impacts on maternal wellbeing. These results suggest urgent response from those in control of the health system to invest more resources to avert the situation in order to enhance maternal health in this country. © 2012 Nyamtema et al.;
Requirements and costs for scaling up comprehensive emergency obstetric and neonatal care in health centres in Tanzania
Get PDFThe objective of this study was to identify and determine the costs of essential components of a resource package and strategies for scaling up comprehensive emergency obstetric and neonatal care services in Tanzania. Essential components were identified through lessons learned during implementation of comprehensive emergency obstetric and neonatal care and regular discussions with key stakeholders. The related costs were collected from the health centres, Tanzania Medical Store Department and non-governmental organizations that had upgraded health centres for comprehensive emergency obstetric and neonatal care services provision. The results showed that the estimated costs of upgrading a health centre to provide comprehensive emergency obstetric and neonatal care services was 4,463 per person for upgrading skills in either in comprehensive emergency obstetric and neonatal care or anaesthesia for three months and 560,802. Scale up required many complementary strategies at all health system levels. Scale up of comprehensive emergency obstetric and neonatal care services in health ccentres in underserved areas is feasible and urgently needed in resource-limited countries.
L'objectif de cette étude était d'identifier et de déterminer les coûts des composants essentiels d'un ensemble de ressources et de stratégies pour étendre les services complets de soins obstétricaux et néonatals d'urgence en Tanzanie. Les éléments essentiels ont été identifiés grâce aux enseignements tirés lors de la mise en oeuvre de soins obstétricaux et néonatals d'urgence complets et de discussions régulières avec les principales parties prenantes. Les coûts correspondants ont été collectés auprès des centres de santé, du département de pharmacie de Tanzanie et d'organisations non gouvernementales qui avaient modernisé les centres de santé pour une prestation complète de services de soins obstétricaux et néonatals d'urgence. Les résultats ont montré que les coûts estimés de la modernisation d'un centre de santé pour fournir des services complets de soins obstétricaux et néonatals d'urgence étaient de 256 650 par personne pour la mise à niveau des compétences en soins obstétricaux et néonatals d'urgence complets ou en anesthésie pour mois et 43 500 . La mise à l'échelle a nécessité de nombreuses stratégies complémentaires à tous les niveaux du système de santé. L'extension des services complets de soins obstétricaux et néonatals d'urgence dans les centres de santé des zones mal desservies est faisable et urgente dans les pays à ressources limitées
 
How can Canadian, African and other health systems benefit from each other?
Get PDFInnovating for Maternal and Child Health in Africa (IMCHA) and Dalhousie University co-hosted a virtual event which provided a platform for exchange regarding implementation research on health systems strengthening, and an opportunity for participants to reflect on research gaps. This report covers key points from the plenary sessions: Delivering integrated health services for neonates; Integrating mental health into routine maternal care in low- and middle-income countries; The importance of leadership and management; Strengthening quality through the use of health data; and, Quality of care and safety standards.Canadian Institutes of Health ResearchGlobal Affairs Canad
Assessment of Health Facility Compliance with Standards and Perception of Adolescents to Quality of Sexual and Reproductive Health Services in Kilindi, Tanga Tanzania
Get PDFPromoting healthy practices during adolescence and taking steps for better protection of young people from health risks is critical to the future of countries‘ health. Young people aged 15-24years account for 60% of the new HIV infection in sub Sahara Africa. The risk of dying from pregnancy-related causes is much higher for adolescents than for older women. Quality of Sexual and Reproductive Health (SRH) services is poor in most areas in rural settings leading to low utilization of services. The study aim at assessing health facility compliance with standards and perception of adolescents to quality of sexual and reproductive health services in Kilindi, Tanga Tanzania. Main Objective of this study was to assess health facilities compliance with standards and perception of adolescents to quality of sexual and reproductive health services in Kilindi, Tanga Tanzania with Specific objectives of determining quality of SRH service in relation to MoHSW standard guidelines in Kilindi District, to assess adolescents perception towards quality of SRH services offered in Health facilities in Kilindi District and to assess attitudes of health workers towards adolescents SRH services in Kilindi District A multi-stage sampling strategy was employed to select the study sample in this cross sectional community and facility based study. Three hundred (300) young people were interviewed while 14-health facilities were assessed. Data were generated using structured interviews and standard serviqual questionnaire and analyzed using stata version 12 statistical packages. Serviqual questionnaires were analyzed using standard serviqual analysis stages where the five quality dimensions of tangibility of service, assurance, empathy, responsiveness and reliability gape scores were assessed. Quality of SRH services was perceived low with average gap score of 4.57 among all fivequality dimensions. Health facilities also showed very low scores of 2.57 out of 4 in terms of functioning fully following the seven standards for provision of Youth friendly services. Knowledge of SRH was high among young people who had higher education (p <0.001). Young people with advanced age also had higher knowledge of STIs. Health care \ud
providers had no enough training on youth friendly SRH services. Quality of SRH services offered by existing health facilities to young people in Kilindi is very low regardless of awareness of young people on key SRH services available at health facilities. It is important for the program and policy makers to ensure standards set for services reflect ability of facilities to offer them\u
Uptake of guidelines on prevention of mother-to-child transmission of HIV in rural Tanzania: time for change
Get PDFGuidelines on prevention of mother-to-child transmission (PMTCT) of human immunodeficiency virus (HIV) are inconsistently implemented in low-income countries. Strategies are needed to improve the uptake of these guidelines to prevent avoidable new HIV infections of infants. In 2010 the World Health Organisation presented its new PMTCT guidelines, offering two options for short courses of antiretroviral prophylaxis: Option A and Option B. Option A consists of antenatal prophylaxis with zidovudine followed by intrapartum and postpartum prophylaxis with single-dose nevirapine and zidovudine plus lamivudine. Option B recommends triple antiretroviral prophylaxis until after finishing breastfeeding. Tanzania has adopted Option A, and it is currently implementing it. A new option termed Option B+ has emerged recently, which recommends providing lifelong antiretroviral treatment to all HIV-positive pregnant women. In this article, we discuss the likely impact of this last PMTCT strategy in rural Africa with an example of an observational cross-sectional analysis in a rural referral hospital in Tanzania aiming to assess the uptake of PMTCT recommendations. Gaps were identified at all steps of the PMTCT pathway. Effective uptake of PMTCT guidelines has been shown to be extremely challenging in this setting. The continuously changing recommendations on PMTCT stress the need for a much simpler and effective approach. We argue in favour of implementing Option B+ in Tanzania. Financial challenges need to be faced, but Option B+ would help to overcome many barriers that prevent guidelines to be implemented in order to increase coverage and ultimately achieve the goal of 'virtual elimination' of mother-to-child transmission in sub-Saharan Africa
