Primary reproductive health care in Tanzania

Sustainability of community-capacity to promote safer motherhood in northwestern Tanzania: what remains?

OBJECTIVE

To examine the remains of the Community-Based Reproductive Health Project (CBRHP) implemented by CARE-Tanzania to address high maternal mortality in two rural districts.

METHODS

In early 2007, data were collected from 29 villages and used to assess sustainability of emergency transport systems, retention of village health workers (VHWs), and their potential impact on maternal health. Surveillance data from the Ministry of Health were reviewed to assess changes in prenatal and service use indicators.

RESULTS

From 2001 through 2006, the CBRHP-trained VHWs have continued to provide education and referrals to women in their communities including prenatal and emergency obstetric care; six villages with emergency transport systems have continued for more than 5 years providing free or low-cost transport to health facilities. Selected maternal and infant health indicators, such as early prenatal care, identification of pregnancy-related danger signs, and data on maternal and infant outcomes, improved in the two targeted districts over time.

CONCLUSIONS

The two components of CBRHP, work of VHWs and community-financing for emergency transport systems in six villages, have continued. Both of these promote maternal health and linkages with the health delivery systems. Surveillance data show changes in maternal health indicators that were targeted by the district-wide CBRHP interventions. Programs such as CBRHP, with focus on capacity-building and empowerment, can assist in mobilizing the formal and informal systems in communities, components of which may be sustained over time.

Potential use of birthweight indicators in rural Tanzania for monitoring malaria control in pregnancy

OBJECTIVE

Birthweight outcomes in rural Tanzania were determined in relation to place of delivery (hospital, dispensary or home), parity and maternal age (adolescent or non-adolescent) in order to evaluate the usefulness of birthweight data for monitoring malaria control in pregnancy.

STUDY DESIGN

Retrospective descriptive study.

METHODS

Birthweight data for the years 1997-2001 were obtained from Kilosa district hospital (n=6269), nine dispensaries (n=3688) and for home deliveries (n=677).

RESULTS

The prevalence of low birthweight in singletons was highest in hospital births (primigravidae, 23.4%; multigravidae, 10.0%). Adolescent primigravidae with home deliveries had the lowest mean birthweight (2.611 kg; 95% confidence interval 2.546-2.676 kg). An excess risk of low birthweight in primigravidae compared with multigravidae was seen with increasing distance from the district hospital. The population attributable risk percent for low birthweight in primigravidae associated with malaria increased with distance from the hospital, from 30% for Kilosa town to 45.7% at distances >50 km. Young adolescent primigravidae were at highest risk of poor birthweight outcomes. Dispensary birthweight data were considered to provide the most representative sample for routine birthweight surveillance.

CONCLUSIONS

Birthweight indicators show that malaria control in pregnancy is poor in this population, deteriorates with distance of place of birth from the main hospital location, and is worst in adolescent primigravidae. Greater attention should be given to the use of birthweight indicators in rural areas of Tanzania for monitoring malaria control in pregnancy.