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Dinho AE, Mårtensson LB, Georgsson M, Laisser R, Knutsson S. Tanzanian midwives' clinical practices and experiences in caring for women with antepartum hemorrhage: a critical incident technique study. BMC Pregnancy Childbirth 2024; 24:613. [PMID: 39313820 PMCID: PMC11421168 DOI: 10.1186/s12884-024-06802-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2024] [Accepted: 09/03/2024] [Indexed: 09/25/2024] Open
Abstract
BACKGROUND Antepartum hemorrhage (APH) is an obstetric emergency that complicates pregnancy worldwide and continues to lead to hemorrhagic conditions in parts of Tanzania. Midwifery education received by midwives consists theoretical knowledge on the subject but with no or minimal practical skills in the laboratory, which may reduce their practical capacity as graduated midwives. This study therefore aimed to explore midwives' clinical actions and experiences regarding the care of women with APH in Mwanza region. METHOD Qualitative, inductive approach with critical incident technique was used. Data were analysed using the critical incident technique, and a question guide consisting of eleven open-ended questions was used to collect data from 44 out of 60 midwives who graduated not less than one year. A total of 522 critical incidents, with 199 actions and 323 experiences, were identified and categorized into five main areas. Ethical approval was obtained. RESULTS Midwives' clinical actions and experiences in caring for women with APH are affected by the knowledge and skills obtained during training at school. They have insufficient theoretical knowledge and practical skills, leading to inadequate identification of the problem and the implementation of care. A need for additional preventive care is described and structural issues, such as co-operation, referral to other instances, access to equipment and relevant treatments need to be improved. CONCLUSION The actions taken to provide care for women with APH were related to their ability to identify problems, implement care and carry out structural initiatives. However, the midwives' experience was influenced by an attempt to understand the seriousness of the situation and the existence of an organizational challenge. The results can provide knowledge and tools to improve midwives' education and clinical practice and in the long run, prevent complications, improves health and minimize suffering in women with APH.
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Affiliation(s)
- Anastazia Emil Dinho
- Archbishop Bishop Anthony Mayala School of Nursing, Department of Community and Maternal and Child health, Catholic University of Health and Allied Sciences, Mwanza, Tanzania.
- School of Health and Welfare, Department of Nursing, School of Health and Welfare, Jönköping University, Jönköping, Sweden.
| | - Lena B Mårtensson
- School of Health Sciences, University of Skövde, Skövde, Sweden
- School of Nursing, Midwifery and Social Work, University of Queensland, St Lucia, Brisbane, Australia
| | - Mattias Georgsson
- School of Health and Welfare, Department of Nursing, School of Health and Welfare, Jönköping University, Jönköping, Sweden
| | - Rose Laisser
- Archbishop Bishop Anthony Mayala School of Nursing, Department of Community and Maternal and Child health, Catholic University of Health and Allied Sciences, Mwanza, Tanzania
| | - Susanne Knutsson
- School of Health and Welfare, Department of Nursing, School of Health and Welfare, Jönköping University, Jönköping, Sweden
- Department of Health and Caring Sciences, Faculty of Health and Life Sciences, Linnaeus University, Växjö, Sweden
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Mwakawanga DL, Sirili N, Chikwala VZ, Mselle LT. "…We never considered it important…": a qualitative study on perceived barriers on use of non-pharmacological methods in management of labour pain by nurse-midwives in eastern Tanzania. BMC Nurs 2024; 23:514. [PMID: 39075525 PMCID: PMC11288077 DOI: 10.1186/s12912-024-02187-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2023] [Accepted: 07/16/2024] [Indexed: 07/31/2024] Open
Abstract
BACKGROUND A significant number of women experience labour without effective pain management and thus suffer from unbearable labour pain to the extent they term labour as the most agonizing event in their lives. Unresolved labour pain can lead to stress, fear, and confusion, which may compromise placental perfusion and lead to birth asphyxia. Although various pharmacological and non-pharmacological labour pain management methods exist, the use of non-pharmacological methods (NPMs) to manage labour pain has remained low in low-resource settings. This paper explored the barriers for using NPMs to manage labour pain by nurse-midwives in eastern Tanzania. METHODS We conducted an exploratory qualitative study with 18 nurse-midwives purposefully recruited from the labour wards of two selected district hospitals in eastern Tanzania. Qualitative content analysis guided the data analysis. RESULTS Two categories illustrating barriers to using NPMs were generated: individual-level and institutional-level barriers. Individual-level barriers include (i) limited competencies of nurse-midwives on the use of NPMs for managing labour pain, (ii) inadequate exposure to labour pain management practices, (iii) misconceptions about labour pain relief, and (iv) a lack of opportunities for knowledge acquisition. The institutional barriers include (i) a critical staff shortage amidst many clients and (ii) an unfavourable healthcare facility environment. CONCLUSION The implementation of NPMs for labour pain management by nurse-midwives in eastern Tanzania faces several institutional and individual barriers. We recommend addressing both supply- and demand-side barriers. Strengthening nurse midwives' competencies in NPMs adoption and use and improving the facility environment to ensure privacy during labour can be a starting point for addressing supply-side issues. We recommend dispelling myths and misconceptions through health promotion education to address demand-side barriers.
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Affiliation(s)
- Dorkasi L Mwakawanga
- Department of Community Health Nursing, School of Nursing, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania.
| | - Nathanael Sirili
- Department of Development Studies, School of Public Health and Social Sciences, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Victor Z Chikwala
- Department of Community Health Nursing, School of Nursing, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Lilian T Mselle
- Department of Clinical Nursing, School of Nursing, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
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Sakurai S, Mwilike B, Horiuchi S. Women's experiences with hypertensive disorders of pregnancy from a national referral hospital in Tanzania: A qualitative study. Jpn J Nurs Sci 2023; 20:e12513. [PMID: 36116438 DOI: 10.1111/jjns.12513] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2022] [Revised: 07/22/2022] [Accepted: 08/22/2022] [Indexed: 01/05/2023]
Abstract
AIM This study aimed to explore the experiences among postpartum women with hypertensive disorders of pregnancy, from pregnancy to admission at a referral hospital in Tanzania. METHODS This was a descriptive cross-sectional design with purposive sampling. Data were collected from semi-structured in-depth interviews with postpartum women diagnosed with hypertensive disorders and who were admitted to the maternity ward of Muhimbili National Hospital. Data were analyzed using NVivo software for qualitative content analysis. RESULTS Fourteen women participated in interviews. Half were primipara and two-thirds had over four antenatal visits. Data analysis yielded four categories and 27 sub-categories. The four categories were: "I'm shocked; I thought I was normal," "The treatment journey," "What health care providers did and did not teach me," "I have a risky future; I hope health care providers can help me." CONCLUSION Women regarded themselves going from being normal to having a risk through the process of experiencing their treatments. They did not expect to be admitted or referred to a major hospital and while they demanded more information and education, they also expressed appreciation for their health care providers. Education during pregnancy addressing their needs and level of understanding is recommended for improvement of early detection and access to the health service.
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Affiliation(s)
| | - Beatrice Mwilike
- Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
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Høifødt AI, Huurnink JME, Egenberg S, Massay DA, Mchome B, Eri TS. The perspectives of nurse-midwives and doctors on clinical challenges of prolonged labor: A qualitative study from Tanzania. Eur J Midwifery 2022; 6:61. [PMID: 36187168 PMCID: PMC9483773 DOI: 10.18332/ejm/152747] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2022] [Revised: 08/05/2022] [Accepted: 08/11/2022] [Indexed: 11/24/2022] Open
Abstract
INTRODUCTION Globally, evidence suggests that one-third of nulliparous women experience delay in the first stage of labor with an increased risk of poor maternal and neonatal outcomes. With this study, we explore how clinical challenges related to prolonged labor are perceived by nurse-midwives and doctors in Tanzania. METHODS A qualitative study with group interviews of either nurse-midwives (7 interviews) or doctors (2 interviews). A total of 37 respondents, among them 32 registered nurse-midwives and 5 doctors participated, all with experience from labor wards. A qualitative content analysis was performed. The study setting comprised one zonal consultant university hospital and one regional referral hospital in Northern Tanzania. RESULTS Clinical challenges were expressed in relation to: 1) various ways of understanding prolonged labor, manifested by variations in expected duration of labor and the usage of different terms to describe prolonged labor; 2) assessing progress in labor, the partograph being described as an important tool but also a template defining a too narrow normal; 3) appropriate intervention at the appropriate time, the respondents reflect on the correct time for artificial rupture of membranes, oxytocin augmentation and cesarean section; 4) monitoring fetal heart rate, distrust in the monitoring equipment with experiences of surprisingly poor neonates; and 5) working as a team, where the perception of urgency varies and distrust is present. CONCLUSIONS Nurse-midwives and doctors in Tanzania face major challenges related to diagnosing prolonged labor, monitoring fetal heart rate and providing high quality health services as a team.
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Affiliation(s)
- Aase I. Høifødt
- Department of Nursing and Health Promotion, Faculty of Health Sciences, Oslo Metropolitan University, Oslo, Norway
| | - Johanne M. E. Huurnink
- Department of Nursing and Health Promotion, Faculty of Health Sciences, Oslo Metropolitan University, Oslo, Norway
| | - Signe Egenberg
- Department of Obstetrics and Gynecology, Stavanger University Hospital, Stavanger, Norway
| | | | - Bariki Mchome
- Department of Obstetrics and Gynecology, Kilimanjaro Christian Medical University College, Moshi, Tanzania
| | - Tine S. Eri
- Department of Nursing and Health Promotion, Faculty of Health Sciences, Oslo Metropolitan University, Oslo, Norway
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Quality and women's satisfaction with maternal referral practices in sub-Saharan African low and lower-middle income countries: a systematic review. BMC Pregnancy Childbirth 2020; 20:682. [PMID: 33176732 PMCID: PMC7656726 DOI: 10.1186/s12884-020-03339-3] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2019] [Accepted: 10/15/2020] [Indexed: 01/23/2023] Open
Abstract
Background sub-Saharan African Low and Lower-Middle Income Countries (sSA LLMICs) have the highest burden of maternal and perinatal morbidity and mortality in the world. Timely and appropriate maternal referral to a suitable health facility is an indicator of effective health systems. In this systematic review we aimed to identify which referral practices are delivered according to accepted standards for pregnant women and newborns in sSA LLMICs by competent healthcare providers in line with the needs of pregnant women. Methods Six electronic databases were systematically searched for primary data studies (2009–2018) in English reporting on maternal referral practices and their effectiveness. We conducted a content analysis guided by a framework for assessing the quality of maternal referral. Quality referral was defined as: timely identification of signal functions, established guidelines or standards, adequate documentation, staff accompaniment and prompt care by competent healthcare providers in the receiving facility. Results Seventeen articles were included in the study. Most studies were quantitative (n = 11). Two studies reported that women were dissatisfied due to delays in referral processes that affected their health. Most articles (10) reported that women were not accompanied to higher levels of care, delays in referral processes, transport challenges and poor referral documentation. Some healthcare providers administered essential drugs such as misoprostol prior to referral. Conclusions Efforts to improve maternal health in LLMICs should aim to enhance maternity care providers’ ability to identify conditions that demand referral. Low cost transport is needed to mitigate barriers of referral. To ensure quality maternal referral, district level health managers should be trained and equipped with the skills needed to monitor and evaluate referral documentation, including quality and efficiency of maternal referrals. Trial registration Systematic review registration: PROSPERO registration CRD42018114261. Supplementary information Supplementary information accompanies this paper at 10.1186/s12884-020-03339-3.
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Harahap NC, Handayani PW, Hidayanto AN. Barriers and technologies of maternal and neonatal referral system in developing countries: A narrative review. INFORMATICS IN MEDICINE UNLOCKED 2019. [DOI: 10.1016/j.imu.2019.100184] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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Solnes Miltenburg A, Kiritta RF, Meguid T, Sundby J. Quality of care during childbirth in Tanzania: identification of areas that need improvement. Reprod Health 2018; 15:14. [PMID: 29374486 PMCID: PMC5787311 DOI: 10.1186/s12978-018-0463-1] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2017] [Accepted: 01/22/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Making use of good, evidence based routines, for management of normal childbirth is essential to ensure quality of care and prevent, identify and manage complications if they occur. Two essential routine care interventions as defined by the World Health Organization are the use of the Partograph and Active Management of the Third Stage of Labour. Both interventions have been evaluated for their ability to assist health providers to detect and deal with complications. There is however little research about the quality of such interventions for routine care. Qualitative studies can help to understand how such complex interventions are implemented. This paper reports on findings from an observation study on maternity wards in Tanzania. METHODS The study took place in the Lake Zone in Tanzania. Between 2014 and 2016 the first author observed and participated in the care for women on maternity wards in four rural and semi-urban health facilities. The data is a result of approximately 1300 hours of observations, systematically recorded primarily in observation notes and notes of informal conversations with health providers, women and their families. Detailed description of care processes were analysed using an ethnographic analysis approach focused on the sequential relationship of the 'stages of labour'. Themes were identified through identification of recurrent patterns. RESULTS Three themes were identified: 1) Women's movement between rooms during birth, 2) health providers' assumptions and hope for a 'normal' birth, 3) fear of poor outcomes that stimulates intervention during birth. Women move between different rooms during childbirth which influences the care they receive. Few women were monitored during their first stage of labour. Routine birth monitoring appeared absent due to health providers 'assumptions and hope for good outcomes. This was rooted in a general belief that most women eventually give birth without problems and the partograph did not correspond with health providers' experience of the birth process. Contextual circumstances also limited health worker ability to act in case of complications. At the same time, fear for being held personally responsible for outcomes triggered active intervention in second stage of labour, even if there was no indication to intervene. CONCLUSIONS Insufficient monitoring leads to poor preparedness of health providers both for normal birth and in case of complications. As a result both underuse and overuse of interventions contribute to poor quality of care. Risk and complication management have for many years been prioritized at the expense of routine care for all women. Complex evaluations are needed to understand the current implementation gaps and find ways for improving quality of care for all women.
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Affiliation(s)
- Andrea Solnes Miltenburg
- Institute of Health and Society, Department of Community Medicine and Global Health, Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Richard Forget Kiritta
- Department of Obstetrics and Gynaecology, Sekotoure Regional Referral Hospital, Mwanza, Mwanza Region Tanzania
| | - Tarek Meguid
- Department of Obstetrics & Gynaecology, Mnazi Mmoja Hospital, Zanzibar, Tanzania
| | - Johanne Sundby
- Institute of Health and Society, Department of Community Medicine and Global Health, Faculty of Medicine, University of Oslo, Oslo, Norway
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Munabi‐Babigumira S, Glenton C, Lewin S, Fretheim A, Nabudere H. Factors that influence the provision of intrapartum and postnatal care by skilled birth attendants in low- and middle-income countries: a qualitative evidence synthesis. Cochrane Database Syst Rev 2017; 11:CD011558. [PMID: 29148566 PMCID: PMC5721625 DOI: 10.1002/14651858.cd011558.pub2] [Citation(s) in RCA: 99] [Impact Index Per Article: 14.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
BACKGROUND In many low- and middle-income countries women are encouraged to give birth in clinics and hospitals so that they can receive care from skilled birth attendants. A skilled birth attendant (SBA) is a health worker such as a midwife, doctor, or nurse who is trained to manage normal pregnancy and childbirth. (S)he is also trained to identify, manage, and refer any health problems that arise for mother and baby. The skills, attitudes and behaviour of SBAs, and the extent to which they work in an enabling working environment, impact on the quality of care provided. If any of these factors are missing, mothers and babies are likely to receive suboptimal care. OBJECTIVES To explore the views, experiences, and behaviours of skilled birth attendants and those who support them; to identify factors that influence the delivery of intrapartum and postnatal care in low- and middle-income countries; and to explore the extent to which these factors were reflected in intervention studies. SEARCH METHODS Our search strategies specified key and free text terms related to the perinatal period, and the health provider, and included methodological filters for qualitative evidence syntheses and for low- and middle-income countries. We searched MEDLINE, OvidSP (searched 21 November 2016), Embase, OvidSP (searched 28 November 2016), PsycINFO, OvidSP (searched 30 November 2016), POPLINE, K4Health (searched 30 November 2016), CINAHL, EBSCOhost (searched 30 November 2016), ProQuest Dissertations and Theses (searched 15 August 2013), Web of Science (searched 1 December 2016), World Health Organization Reproductive Health Library (searched 16 August 2013), and World Health Organization Global Health Library for WHO databases (searched 1 December 2016). SELECTION CRITERIA We included qualitative studies that focused on the views, experiences, and behaviours of SBAs and those who work with them as part of the team. We included studies from all levels of health care in low- and middle-income countries. DATA COLLECTION AND ANALYSIS One review author extracted data and assessed study quality, and another review author checked the data. We synthesised data using the best fit framework synthesis approach and assessed confidence in the evidence using the GRADE-CERQual (Confidence in the Evidence from Reviews of Qualitative research) approach. We used a matrix approach to explore whether the factors identified by health workers in our synthesis as important for providing maternity care were reflected in the interventions evaluated in the studies in a related intervention review. MAIN RESULTS We included 31 studies that explored the views and experiences of different types of SBAs, including doctors, midwives, nurses, auxiliary nurses and their managers. The included studies took place in Africa, Asia, and Latin America.Our synthesis pointed to a number of factors affecting SBAs' provision of quality care. The following factors were based on evidence assessed as of moderate to high confidence. Skilled birth attendants reported that they were not always given sufficient training during their education or after they had begun clinical work. Also, inadequate staffing of facilities could increase the workloads of skilled birth attendants, make it difficult to provide supervision and result in mothers being offered poorer care. In addition, SBAs did not always believe that their salaries and benefits reflected their tasks and responsibilities and the personal risks they undertook. Together with poor living and working conditions, these issues were seen to increase stress and to negatively affect family life. Some SBAs also felt that managers lacked capacity and skills, and felt unsupported when their workplace concerns were not addressed.Possible causes of staff shortages in facilities included problems with hiring and assigning health workers to facilities where they were needed; lack of funding; poor management and bureaucratic systems; and low salaries. Skilled birth attendants and their managers suggested factors that could help recruit, keep, and motivate health workers, and improve the quality of care; these included good-quality housing, allowances for extra work, paid vacations, continuing education, appropriate assessments of their work, and rewards.Skilled birth attendants' ability to provide quality care was also limited by a lack of equipment, supplies, and drugs; blood and the infrastructure to manage blood transfusions; electricity and water supplies; and adequate space and amenities on maternity wards. These factors were seen to reduce SBAs' morale, increase their workload and infection risk, and make them less efficient in their work. A lack of transport sometimes made it difficult for SBAs to refer women on to higher levels of care. In addition, women's negative perceptions of the health system could make them reluctant to accept referral.We identified some other factors that also may have affected the quality of care, which were based on findings assessed as of low or very low confidence. Poor teamwork and lack of trust and collaboration between health workers appeared to negatively influence care. In contrast, good collaboration and teamwork appeared to increase skilled birth attendants' motivation, their decision-making abilities, and the quality of care. Skilled birth attendants' workloads and staff shortages influenced their interactions with mothers. In addition, poor communication undermined trust between skilled birth attendants and mothers. AUTHORS' CONCLUSIONS Many factors influence the care that SBAs are able to provide to mothers during childbirth. These include access to training and supervision; staff numbers and workloads; salaries and living conditions; and access to well-equipped, well-organised healthcare facilities with water, electricity, and transport. Other factors that may play a role include the existence of teamwork and of trust, collaboration, and communication between health workers and with mothers. Skilled birth attendants reported many problems tied to all of these factors.
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Affiliation(s)
| | - Claire Glenton
- Norwegian Institute of Public HealthPO Box 4404, NydalenOsloNorwayN‐0403
| | - Simon Lewin
- Norwegian Institute of Public HealthPO Box 4404, NydalenOsloNorwayN‐0403
- South African Medical Research CouncilHealth Systems Research UnitPO Box 19070TygerbergSouth Africa7505
| | - Atle Fretheim
- Norwegian Institute of Public HealthPO Box 4404, NydalenOsloNorwayN‐0403
- University of OsloInstitute of Health and SocietyOsloNorway
| | - Harriet Nabudere
- Uganda National Health Research OrganisationPlot 2, Berkeley Lane, EntebbeEntebbeUganda
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Saronga HP, Duysburgh E, Massawe S, Dalaba MA, Wangwe P, Sukums F, Leshabari M, Blank A, Sauerborn R, Loukanova S. Cost-effectiveness of an electronic clinical decision support system for improving quality of antenatal and childbirth care in rural Tanzania: an intervention study. BMC Health Serv Res 2017; 17:537. [PMID: 28784130 PMCID: PMC5547541 DOI: 10.1186/s12913-017-2457-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2015] [Accepted: 07/17/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND QUALMAT project aimed at improving quality of maternal and newborn care in selected health care facilities in three African countries. An electronic clinical decision support system was implemented to support providers comply with established standards in antenatal and childbirth care. Given that health care resources are limited and interventions differ in their potential impact on health and costs (efficiency), this study aimed at assessing cost-effectiveness of the system in Tanzania. METHODS This was a quantitative pre- and post- intervention study involving 6 health centres in rural Tanzania. Cost information was collected from health provider's perspective. Outcome information was collected through observation of the process of maternal care. Incremental cost-effectiveness ratios for antenatal and childbirth care were calculated with testing of four models where the system was compared to the conventional paper-based approach to care. One-way sensitivity analysis was conducted to determine whether changes in process quality score and cost would impact on cost-effectiveness ratios. RESULTS Economic cost of implementation was 167,318 USD, equivalent to 27,886 USD per health center and 43 USD per contact. The system improved antenatal process quality by 4.5% and childbirth care process quality by 23.3% however these improvements were not statistically significant. Base-case incremental cost-effectiveness ratios of the system were 2469 USD and 338 USD per 1% change in process quality for antenatal and childbirth care respectively. Cost-effectiveness of the system was sensitive to assumptions made on costs and outcomes. CONCLUSIONS Although the system managed to marginally improve individual process quality variables, it did not have significant improvement effect on the overall process quality of care in the short-term. A longer duration of usage of the electronic clinical decision support system and retention of staff are critical to the efficiency of the system and can reduce the invested resources. Realization of gains from the system requires effective implementation and an enabling healthcare system. TRIAL REGISTRATION Registered clinical trial at www.clinicaltrials.gov ( NCT01409824 ). Registered May 2009.
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Affiliation(s)
- Happiness Pius Saronga
- Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
- Institute of Public Health, University of Heidelberg, Heidelberg, Germany
| | - Els Duysburgh
- International Centre for Reproductive Health (ICRH), Ghent University, Ghent, Belgium
| | - Siriel Massawe
- Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Maxwell Ayindenaba Dalaba
- Navrongo Health Research Centre, Navrongo, Ghana
- Institute of Public Health, University of Heidelberg, Heidelberg, Germany
| | - Peter Wangwe
- Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Felix Sukums
- Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
- Department of Clinical Pharmacology and Pharmacoepidemiology, University of Heidelberg, Heidelberg, Germany
| | | | - Antje Blank
- Department of Clinical Pharmacology and Pharmacoepidemiology, University of Heidelberg, Heidelberg, Germany
| | - Rainer Sauerborn
- Institute of Public Health, University of Heidelberg, Heidelberg, Germany
| | - Svetla Loukanova
- Department of General Medicine and Implementation Research, University of Heidelberg, Heidelberg, Germany
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Mirkuzie AH, Sisay MM, Bedane MM. High proportions of obstetric referrals in Addis Ababa: the case of term premature rupture of membranes. BMC Res Notes 2016; 9:40. [PMID: 26809734 PMCID: PMC4724955 DOI: 10.1186/s13104-016-1852-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2014] [Accepted: 01/11/2016] [Indexed: 11/10/2022] Open
Abstract
Background The Public Health Centers (HCs) provide basic obstetric and neonatal care to about 80 % of the eligible population in Addis Ababa. Hospitals provide comprehensive services and are referral centers for complications that cannot be managed at the HCs.
This study assessed the proportion of obstetric referrals in general and referrals due to premature rupture of membranes (PROM) at term in particular, from the HCs in Addis Ababa and explored its appropriateness and management in hospitals. Methods The study used a sequential explanatory mixed methods design. Routine retrospective data were collected from ten randomly selected HCs in 2012. Key informant interviews were conducted using a guide developed following a preliminary analysis of the quantitative data. Ten head midwives, one from each health center participated in the interviews. Results Of the 9340 mothers who sought skilled birth care in the ten HCs in 2012, 2820 (30.3 %) were diagnosed with obstetric complications and referred to hospital. Term PROM accounted for 557 (19.7 %) of the referrals and it was widely varied across the HCs. Fifteen (7.8 %) mothers who were referred for PROM, had intact membranes upon hospital examinations. Forty-two (77.8 %) of the referred mothers who had spontaneous labour and delivery could have been misclassified as not having labour upon referral. In the interviews, variations in diagnosing and managing term PROM were identified as themes. Three HCs relayed solely on mothers’ self reports of amniotic fluid leakage to diagnose, two HCs did complementary speculum/vaginal examination, three HCs monitored sign of labour on top of confirming the leakage. Regarding management, two HCs practiced expectant management, three referred mothers after 30 min of observation while others issued referral right away. All providers reported the lack of clinical guidelines for most common obstetric problems in their HC. Conclusions The study reported large proportion of obstetric referrals in general and PROM referrals in particular as well as variations in diagnosing and managing term PROM. These could largely be attributed to lack of clinical guidelines for most common obstetric complications at the HCs and competency gap among providers. Addressing the identified gaps and strengthening the primary care settings could contribute to improved quality of obstetric care and outcomes. Electronic supplementary material The online version of this article (doi:10.1186/s13104-016-1852-6) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Alemnesh H Mirkuzie
- Center for International Health, University of Bergen, Årstadv 21, Overlegedanielsenshus, 5020, Bergen, Norway.
| | - Mitike Molla Sisay
- School of Public Health, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia.
| | - Mulu Muleta Bedane
- WAHA International, University of Gondar, Post Box 41822, Gondar, Ethiopia.
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