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Galgalo DA, Mokaya P, Chauhan S, Kiptulon EK, Wami GA, Várnagy Á, Prémusz V. Utilization of maternal health care services among pastoralist communities in Marsabit County, Kenya: a cross-sectional survey. Reprod Health 2024; 21:126. [PMID: 39223560 PMCID: PMC11370096 DOI: 10.1186/s12978-024-01865-3] [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: 03/31/2024] [Accepted: 08/15/2024] [Indexed: 09/04/2024] Open
Abstract
BACKGROUND Improving maternal healthcare services is crucial to achieving the Sustainable Development Goal (SDG-3), which aims to reduce maternal mortality and morbidity. There is a consensus among different researchers that proper utilization of maternal healthcare services can improve the reproductive health of women, and this can be achieved by providing Antenatal Care (ANC) during pregnancy, Health Facility Delivery (HFD), and Postnatal Care (PNC) to all pregnant women. The main aim of this study was to investigate the utilization and factors associated with maternal and child healthcare services among women of reproductive age in the pastoralist communities in Kenya. METHODS A cross-sectional survey was conducted among 180 pastoralist women who gave birth in the past two years across ten mobile villages in Marsabit County between 2nd January and 29th February 2019. Three key outcomes were analyzed, whether they attended ANC 4+ visits, delivered at HF, and received PNC. Pearson χ2 test and multivariate logistic regression analysis were conducted by IBM SPSS27.0 following Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) guidelines. The significance level was set at p < 0.05. RESULTS Of the 180 eligible pastoralist women (mean age 27.44 ± 5.13 years), 92.2% were illiterate, 93.9% were married, 33.3% were in polygamy, and 14.4% had mobile phones. The median commuting distance was 15.00 (10-74) km, 41.7% attended ANC 4+, 33.3% HFD, and 42.8% PNC. Those women residing close (≤ 15 km) to a health facility had a threefold higher ANC 4+ (OR 3.10, 95% CI 1.47-6.53), 2.8-fold higher HFD (OR 2.80, 95% CI 1.34-5.84), and 2.5-fold higher PNC (OR 2.49, 95% CI 1.19-5.22) probability. The likelihood was 30-fold higher for ANC 4+ (OR 29.88, 95% CI 6.68-133.62), 2.5-fold higher for HFD (OR 2.56, 95% CI 0.99-6.63), and 60-fold higher for PNC (OR 60.46, 95% CI 10.43-350.55) in women with mobile phones. A monogamous marriage meant a fivefold higher ANC 4+ (OR 5.17, 95% CI 1.88-14.23), 1.6-fold higher HFD (OR 1.67, 95% CI 0.77-3.62), and a sevenfold higher PNC (OR 7.05, 95% CI 2.35-21.19) likelihood. Hosmer Lemeshow test indicated a good-fitting model for ANC 4+, HFD, and PNC (p = 0.790, p = 0.441, p = 0.937, respectively). CONCLUSION In conclusion, the utilization of three essential maternal health services is low. Geographic proximity, monogamous marriage, and possession of mobile phones were significant predictors. Therefore, it is recommended that stakeholders take the initiative to bring this service closer to the pastoralist community by providing mobile health outreach and health education.
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Affiliation(s)
- Dahabo Adi Galgalo
- Doctoral School of Health Science, Faculty of Health Science, University of Pécs, Vörösmarty u. 4, Pecs, 7621, Hungary
- Ministry of Health, Marsabit County, Moyale Sub-County, PO Box 57 (60 700), Kenya
- National Laboratory on Human Reproduction, University of Pécs, Pecs, 7622, Hungary
| | - Peter Mokaya
- Doctoral School of Health Science, Faculty of Health Science, University of Pécs, Vörösmarty u. 4, Pecs, 7621, Hungary
| | - Shalini Chauhan
- Doctoral School of Health Science, Faculty of Health Science, University of Pécs, Vörösmarty u. 4, Pecs, 7621, Hungary
| | - Evans Kasmai Kiptulon
- Doctoral School of Health Science, Faculty of Health Science, University of Pécs, Vörösmarty u. 4, Pecs, 7621, Hungary
| | - Girma Alemu Wami
- Doctoral School of Health Science, Faculty of Health Science, University of Pécs, Vörösmarty u. 4, Pecs, 7621, Hungary
| | - Ákos Várnagy
- National Laboratory on Human Reproduction, University of Pécs, Pecs, 7622, Hungary
- Department of Obstetrics and Gynecology, Medical School, University of Pécs, Pecs, 7624, Hungary
- HUN-REN-PTE Human Reproduction Research Group, Pecs, 7624, Hungary
| | - Viktória Prémusz
- Doctoral School of Health Science, Faculty of Health Science, University of Pécs, Vörösmarty u. 4, Pecs, 7621, Hungary.
- National Laboratory on Human Reproduction, University of Pécs, Pecs, 7622, Hungary.
- HUN-REN-PTE Human Reproduction Research Group, Pecs, 7624, Hungary.
- Institute of Physiotherapy and Sport Sciences, Faculty of Health Sciences, University of Pécs, Pecs, 7621, Hungary.
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Adinani H, Amour C, Msuya S, Anthony CS, Mitao M, Mwita W, Renju J. Prevalence and factors associated with early postnatal care utilization among women of reproductive age in Tanzania: analysis of Tanzania demographic health survey 2015/16. Pan Afr Med J 2024; 47:163. [PMID: 39036019 PMCID: PMC11260057 DOI: 10.11604/pamj.2024.47.163.34368] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2022] [Accepted: 02/19/2024] [Indexed: 07/23/2024] Open
Abstract
Introduction postnatal care (PNC) is critical for the health and survival of the mother and the newborn. The timing of the first postnatal checkup is crucial for the early identification and treatment of complications. Late or zero attendance of postnatal checkups negatively influences the health of the mother and the newborn. The study's purpose is to determine the prevalence and factors associated with early postnatal care utilization among women of reproductive age (WRA) in Tanzania. Methods this is an analytical cross-sectional study, using Tanzania demographic health survey data for 2015/16. Women of reproductive age (15-49 years) who gave birth 5 years prior the survey were analyzed. Data analysis was performed using Stata software Version 15. The Poisson regression analysis was used to assess factors associated with early PNC. Results the prevalence of early PNC utilization in Tanzania was 36%. The identified determinants for early PNC were geographical zone, place of residence, access to media, place of delivery and mode of delivery. The prevalence of early PNC was higher among mothers with access to media, with caesarian delivery and to those with facility delivery. The prevalence was low among mothers who lived in rural areas, from southwest and lake zones. Conclusion the coverage of early PNC was found to be low in Tanzania. Interventions informed by the identified factors need to be designed and implemented to improve the coverage of early PNC.
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Affiliation(s)
- Hamidu Adinani
- Institute of Public Health, Department of Epidemiology and Biostatistics, Kilimanjaro Christian Medical University College (KCMUCo), PO. Box 2240, Moshi, Tanzania
| | - Caroline Amour
- Institute of Public Health, Department of Epidemiology and Biostatistics, Kilimanjaro Christian Medical University College (KCMUCo), PO. Box 2240, Moshi, Tanzania
| | - Sia Msuya
- Institute of Public Health, Department of Epidemiology and Biostatistics, Kilimanjaro Christian Medical University College (KCMUCo), PO. Box 2240, Moshi, Tanzania
| | - Cecilia S Anthony
- Institute of Public Health, Department of Epidemiology and Biostatistics, Kilimanjaro Christian Medical University College (KCMUCo), PO. Box 2240, Moshi, Tanzania
| | - Modesta Mitao
- Institute of Public Health, Department of Epidemiology and Biostatistics, Kilimanjaro Christian Medical University College (KCMUCo), PO. Box 2240, Moshi, Tanzania
| | - Winfrida Mwita
- Institute of Public Health, Department of Epidemiology and Biostatistics, Kilimanjaro Christian Medical University College (KCMUCo), PO. Box 2240, Moshi, Tanzania
| | - Jenny Renju
- Institute of Public Health, Department of Epidemiology and Biostatistics, Kilimanjaro Christian Medical University College (KCMUCo), PO. Box 2240, Moshi, Tanzania
- Department of Population Health London School of Hygiene and Tropical Medicine Keppel St, London, England
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Mlandu C, Matsena-Zingoni Z, Musenge E. Predicting the drop out from the maternal, newborn and child healthcare continuum in three East African Community countries: application of machine learning models. BMC Med Inform Decis Mak 2023; 23:191. [PMID: 37749542 PMCID: PMC10518924 DOI: 10.1186/s12911-023-02305-1] [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: 10/13/2022] [Accepted: 09/21/2023] [Indexed: 09/27/2023] Open
Abstract
BACKGROUND For optimal health, the maternal, newborn, and child healthcare (MNCH) continuum necessitates that the mother/child receive the full package of antenatal, intrapartum, and postnatal care. In sub-Saharan Africa, dropping out from the MNCH continuum remains a challenge. Using machine learning, the study sought to forecast the MNCH continuum drop out and determine important predictors in three East African Community (EAC) countries. METHODS The study utilised Demographic Health Surveys data from the Democratic Republic of Congo (DRC) (2013/14), Kenya (2014) and Tanzania (2015/16). STATA 17 was used to perform the multivariate logistic regression. Python 3.0 was used to build five machine learning classification models namely the Logistic Regression, Random Forest, Decision Tree, Support Vector Machine and Artificial Neural Network. Performance of the models was assessed using Accuracy, Precision, Recall, Specificity, F1 score and area under the Receiver Operating Characteristics (AUROC). RESULTS The prevalence of the drop out from the MNCH continuum was 91.0% in the DRC, 72.4% in Kenya and 93.6% in Tanzania. Living in the rural areas significantly increased the odds of dropping out from the MNCH continuum in the DRC (AOR:1.76;95%CI:1.30-2.38), Kenya (AOR:1.23;95%CI:1.03-1.47) and Tanzania (AOR:1.41;95%CI:1.01-1.97). Lower maternal education also conferred a significant increase in the DRC (AOR:2.16;95%CI:1.67-2.79), Kenya (AOR:1.56;95%CI:1.30-1.84) and Tanzania (AOR:1.70;95%CI:1.24-2.34). Non exposure to mass media also conferred a significant positive influence in the DRC (AOR:1.49;95%CI:1.15-1.95), Kenya (AOR:1.46;95%CI:1.19-1.80) and Tanzania (AOR:1.65;95%CI:1.13-2.40). The Random Forest exhibited superior predictive accuracy (Accuracy = 75.7%, Precision = 79.1%, Recall = 92.1%, Specificity = 51.6%, F1 score = 85.1%, AUROC = 70%). The top four predictors with the greatest influence were household wealth, place of residence, maternal education and exposure to mass media. CONCLUSIONS The MNCH continuum dropout rate is very high in the EAC countries. Maternal education, place of residence, and mass media exposure were common contributing factors to the drop out from MNCH continuum. The Random Forest had the highest predictive accuracy. Household wealth, place of residence, maternal education and exposure to mass media were ranked among the top four features with significant influence. The findings of this study can be used to support evidence-based decisions in MNCH interventions and to develop web-based services to improve continuity of care retention.
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Affiliation(s)
- Chenai Mlandu
- School of Public Health, University of Witwatersrand, Johannesburg, South Africa.
| | | | - Eustasius Musenge
- School of Public Health, University of Witwatersrand, Johannesburg, South Africa
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Bintabara D, Mwampagatwa I. Socioeconomic inequalities in maternal healthcare utilization: An analysis of the interaction between wealth status and education, a population-based surveys in Tanzania. PLOS GLOBAL PUBLIC HEALTH 2023; 3:e0002006. [PMID: 37310944 DOI: 10.1371/journal.pgph.0002006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/02/2023] [Accepted: 05/08/2023] [Indexed: 06/15/2023]
Abstract
Limited scientific, evidence has so far described the interactions between socioeconomic factors and the gap of inequalities in maternal healthcare utilization. This study assessed the interaction between wealth status and education to identify women with greater disadvantage. This analysis used secondary data from the three most recent rounds (2004, 2010, and 2016) of the Tanzania Demographic Health Survey (TDHS). Maternal healthcare utilization was assessed based on six services (outcomes) which are i) booking during the first trimester (bANC), ii) at least four antenatal visits (ANC4+), iii) adequate antenatal care (aANC), iv) facility-based delivery (FBD), v) skilled birth attendance (SBA), vi) cesarean section delivery (CSD). The concentration curve and the concentration index were used to measure socioeconomic inequality in maternal healthcare utilization outcomes. The interaction coefficients suggest that each unit increase in the wealth status is significantly associated with higher odds of utilizing all maternal healthcare services for women with primary and secondary or higher education compared to those with no education (booking during the first trimester [AOR = 1.30; 95% CI: 1.08-1.57], at least four antenatal visits [AOR = 1.16; 95% CI: 1.01-1.33], facility-based delivery [AOR = 1.29; 95% CI: 1.12-1.48], skilled birth attendance [AOR = 1.31; 95% CI: 1.15-1.49]). The highest wealth-related inequality in bANC (EI: 0.166), at least four antenatal visits (EI: 0.259), FBD (EI: 0.323) and skilled birth attendance (EI: 0.328) (P < 0.05) was observed among women with primary and secondary or higher education. These findings provide strong evidence that there is an interaction effect between education attainment and wealth status in socioeconomic inequalities of maternal health services utilization. Therefore, any approach which will address both women's education and wealth status might be the first step to reducing socioeconomic inequalities in maternal health services utilization in Tanzania.
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Affiliation(s)
| | - Ipyana Mwampagatwa
- Department of Obstetrics and Gynecology, The University of Dodoma, Dodoma, Tanzania
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Bantie B, Kassaw Yirga G, Ayenew YE, Nuru Muhamed A, Tassew SF, Kassie YT, Tiruneh CM, Moges N, Birhane BM, Anley DT, Anteneh RM, Dessie AM. Deworming utilization among pregnant mothers with at least one antenatal care follow-up in Ethiopia, 2022:- A multilevel analysis. PLoS One 2023; 18:e0279967. [PMID: 36662678 PMCID: PMC9858040 DOI: 10.1371/journal.pone.0279967] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2022] [Accepted: 12/19/2022] [Indexed: 01/21/2023] Open
Abstract
BACKGROUND Soil-transmitted helminthes (STHs) are the major public health problems that affect the health of pregnant women and their incoming newborns. In Ethiopia, about 33.35% of pregnant women were affected by these infections. Utilization of deworming medication during pregnancy is the main strategy endorsed by the World Health Organization (WHO) to reduce the burden of STH-induced anemia and its related complications. However, information related to the coverage and its individual as well as community-level factors on the utilization of deworming medication among pregnant mothers with at least one antenatal care (ANC) visit is limited in Ethiopia. METHODS A nationwide population-based cross-sectional study was conducted from January 18 to June 27, 2016. The information was obtained from the 2016 Ethiopian Demographic Health Survey (EDHS 2016), which can be accessed at: https://www.dhsprogram.com. A weighted sample of 4690 pregnant women selected using a two-stage stratified cluster sampling technique was included in the final analysis. A Multi-variable multilevel binary logistic regression model was fitted to identify the determinants of the utilization of deworming medication during pregnancy. Log-likelihood ration (LLR), deviance and Akaike's Information Criterion (AIC) were used to select the best fitted model in the multilevel analysis. Statistical significance was declared at p-value <0.05. RESULT From a total of 4690 mothers included in the final analysis, only 365 (7.8%) of them utilized deworming medication in pregnancy. After controlling for confounding effects, having four or more Antenatal care (ANC) visits, having functional working status, intake of iron folic acid (IFA) tablets and coming from a community with a low poverty level increases the odds of utilization of deworming medication during pregnancy. CONCLUSION AND RECOMMENDATION In this study, less than one in ten pregnant mothers takes deworming medication. Mothers with less than four ANC visits, who did not receive IFA tablets, who came from a community with a high poverty level, and mothers with no good functional status were at the greatest risk of not receiving deworming medication during pregnancy. Sustained efforts need to be undertaken to increase the socioeconomic status of the community and to scale up the health care utilization behaviors of pregnant mothers.
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Affiliation(s)
- Berihun Bantie
- Department of Comprehensive Nursing, College of Health Science, Debre Tabor University, Debre Tabor, Northwest Ethiopia
| | - Gebrie Kassaw Yirga
- Department of Comprehensive Nursing, College of Health Science, Debre Tabor University, Debre Tabor, Northwest Ethiopia
| | - Yeshiambaw Eshetie Ayenew
- Department of Comprehensive Nursing, College of Health Science, Debre Tabor University, Debre Tabor, Northwest Ethiopia
| | - Ahmed Nuru Muhamed
- Department of Nursing, College of Medicine and Health Science, Wolkite University, Welkite, Southern Ethiopia
| | - Sheganew Fetene Tassew
- Department of Emergency and Critical Care Nursing, College of Health science, Debre Tabor University, Debre Tabor, Northwest Ethiopia
| | - Yohannes Tesfahun Kassie
- Department of Emergency and Critical Care Nursing, College of Health science, Debre Tabor University, Debre Tabor, Northwest Ethiopia
| | - Chalie Marew Tiruneh
- Department of Pediatrics and Child Health, College of Health Science, Debre Tabor University, Derbre Tabor, Northwest Ethiopia
| | - Natnael Moges
- Department of Pediatrics and Child Health, College of Health Science, Debre Tabor University, Derbre Tabor, Northwest Ethiopia
| | - Binyam Minuye Birhane
- Department of Pediatrics and Child Health, College of Health Science, Debre Tabor University, Derbre Tabor, Northwest Ethiopia
| | - Denekew Tenaw Anley
- Department of Public Health, College of Health Science, Debre Tabor University, Debre Tabor, Northwest Ethiopia
| | - Rahel Mulatie Anteneh
- Department of Public Health, College of Health Science, Debre Tabor University, Debre Tabor, Northwest Ethiopia
| | - Anteneh Mengist Dessie
- Department of Public Health, College of Health Science, Debre Tabor University, Debre Tabor, Northwest Ethiopia
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Mwansisya T, Mbekenga C, Isangula K, Mwasha L, Mbelwa S, Lyimo M, Kisaka L, Mathias V, Pallangyo E, Edwards G, Mantel M, Konteh S, Rutachunzibwa T, Mrema S, Kidanto H, Temmerman M. The impact of training on self-reported performance in reproductive, maternal, and newborn health service delivery among healthcare workers in Tanzania: a baseline- and endline-survey. Reprod Health 2022; 19:143. [PMID: 35725562 PMCID: PMC9210613 DOI: 10.1186/s12978-022-01452-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2021] [Accepted: 06/01/2022] [Indexed: 11/21/2022] Open
Abstract
Background Delivery of quality reproductive health services has been documented to depend on the availability of healthcare workers who are adequately supported with appropriate training. However, unmet training needs among healthcare workers in reproductive, maternal, and newborn health (RMNH) in low-income countries remain disproportionately high. This study investigated the effectiveness of training with onsite clinical mentorship towards self-reported performance in RMNH among healthcare workers in Mwanza Region, Tanzania. Methods The study used a quasi-experimental design with pre-and post-intervention evaluation strategy. The baseline was compared with two endline groups: those with intervention (training and onsite mentorship) and those without. The differences among the three groups in the sociodemographic characteristics were analyzed by using chi-square test for categorical variables, independent-sample t-test for continuous variables and Mann–Whitney U test for ordinal or skewed continuous data. The independent sample t-test was used to determine the effect of the intervention by comparing the computed self-reported performance on RMNH services between the intervention and control groups. The paired-samples t-test was used to measure the differences between before and after intervention groups. Significance was set at a 95% confidence interval with p ≤ 0.05. Results The study included a sample of 216 participants with before and after intervention groups comprising of 95 (44.0%) and 121 (56.0%) in the control group. The comparison between before and after intervention groups revealed a statistically significant difference (p ≤ 0.05) in all the dimensions of the self-reported performance scores. However, the comparison between intervention groups and controls indicated a statistical significant difference on intra-operative care (t = 3.10, df = 216, p = 0.002), leadership skills (t = 1.85, df = 216, p = 0.050),
Comprehensive emergency obstetric and newborn care (CEMONC) (t = 34.35, df = 216, p ≤ 0.001), and overall self-reported performance in RMNH (t = 3.15, df = 216, p = 0.002). Conclusions This study revealed that the training and onsite clinical mentorship to have significant positive changes in self-reported performance in a wide range of RMNH services especially on intra-operative care, leadership skills and CEMONC. However, further studies with rigorous designs are warranted to evaluate the long-term effect of such training programs on RMNH outcomes. Reproductive maternal and newborn health (RMNH) in low- and middle-income countries continue to face critical challenges. Training healthcare workers especially using a combined approach (training followed by immediate clinical mentorship) in RMNH have been documented as an essential strategy to reduce maternal and neonatal mortality in low-and middle-income countries closer to those in high-income countries. This study investigated the effectiveness of a Continuous Professional Development (CPD) trainings on performance among healthcare workers in Mwanza Region. The study included a sample of 216 participants with before and after intervention groups comprising of 95 participants and control group comprising of 121 participants. The findings revealed that in comparison between before and after intervention groups all dimensions of the self-reported TNA questionnaire had a statistically significant difference. However, the comparison between intervention and controls groups indicated a statistical significant difference on leadership skills, intra-operative care,
Comprehensive emergency obstetric and newborn care (CEMONC) and overall RMNH self-reported performance. In conclusion, the findings demonstrated that healthcare workers’ self-identified and prioritized training needs that are supported with clinical mentorship results in significant positive changes in performance across a wide range of RMNH tasks. Therefore, conducting TNA that is followed by training and mentorship according to the identified needs among healthcare workers plays a significant role in improving performance on RMNH services among healthcare workers.
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Affiliation(s)
- Tumbwene Mwansisya
- School of Nursing and Midwifery, The Aga Khan University, Dar es Salaam, Tanzania.
| | - Columba Mbekenga
- School of Nursing and Midwifery, The Aga Khan University, Dar es Salaam, Tanzania
| | - Kahabi Isangula
- School of Nursing and Midwifery, The Aga Khan University, Dar es Salaam, Tanzania
| | - Loveluck Mwasha
- School of Nursing and Midwifery, The Aga Khan University, Dar es Salaam, Tanzania
| | - Stewart Mbelwa
- School of Nursing and Midwifery, The Aga Khan University, Dar es Salaam, Tanzania
| | - Mary Lyimo
- School of Nursing and Midwifery, The Aga Khan University, Dar es Salaam, Tanzania
| | - Lucy Kisaka
- School of Nursing and Midwifery, The Aga Khan University, Dar es Salaam, Tanzania
| | - Victor Mathias
- School of Nursing and Midwifery, The Aga Khan University, Dar es Salaam, Tanzania
| | - Eunice Pallangyo
- School of Nursing and Midwifery, The Aga Khan University, Dar es Salaam, Tanzania
| | - Grace Edwards
- School of Nursing and Midwifery, The Aga Khan University, Kampala, Uganda
| | - Michaela Mantel
- Centre of Excellence in Women and Child Health, The Aga Khan University, Nairobi, Kenya
| | | | | | | | - Hussein Kidanto
- Department of Obstetrics and Gynecology, Aga Khan University, Dar es Salaam, Tanzania
| | - Marleen Temmerman
- Centre of Excellence in Women and Child Health, The Aga Khan University, Nairobi, Kenya
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Isangula K, Mbekenga C, Mwansisya T, Mwasha L, Kisaka L, Selestine E, Siso D, Rutachunzibwa T, Mrema S, Pallangyo E. Healthcare Providers' Experiences With a Clinical Mentorship Intervention to Improve Reproductive, Maternal and Newborn Care in Mwanza, Tanzania. FRONTIERS IN HEALTH SERVICES 2022; 2:792909. [PMID: 36925824 PMCID: PMC10012706 DOI: 10.3389/frhs.2022.792909] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/11/2021] [Accepted: 02/23/2022] [Indexed: 06/18/2023]
Abstract
INTRODUCTION There is increasing evidence suggesting that clinical mentorship (CM) involving on-the-job training is one of the critical resources-friendly entry points for strengthening the knowledge and skills of healthcare providers (HCPs), which in turn facilitate the delivery of effective reproductive, maternal, and newborn health (RMNH) care. The article explores the experiences of HCPs following participation in the CM program for RMNH in eight districts of Mwanza Region in Tanzania. MATERIALS AND METHODS A qualitative descriptive design employing data from midterm project review meetings and Key Informant Interviews (KIIs) with purposefully selected HCPs (mentors and mentees) and District Medical Officers (DMOs) during endline evaluation were employed. Interview data were managed using Nvivo Software and analyzed thematically. RESULTS A total of 42 clinical mentors and master mentors responded to a questionnaire during the midterm review meeting. Then, a total of 17 KIIs were conducted with Mentees (8), Mentors (5), and DMOs (4) during endline evaluation. Five key themes emerged from participants' accounts: (i) the topics covered during CM visits; (ii) the benefits of CM; (iii) the challenges of CM; (iv) the drivers of CM sustainability; and (iv) suggestions for CM improvement. The topics of CM covered during visits included antenatal care, neonatal resuscitation, pregnancy monitoring, management of delivery complications, and infection control and prevention. The benefits of CM included increased knowledge, skills, confidence, and change in HCP's attitude and increased client service uptake, quality, and efficiency. The challenges of CM included inadequate equipment for learning and practice, the limited financial incentive to mentees, shortage of staff and time constraints, and weaker support from management. The drivers of CM sustainability included the willingness of mentees to continue with clinical practice, ongoing peer-to-peer mentorship, and integration of the mentorship program into district health plans. Finally, the suggestions for CM improvement included refresher training for mentors, engagement of more senior mentors, and extending mentorship beyond IMPACT catchment facilities. CONCLUSION CM program appears to be a promising entry point to improving competence among HCPs and the quality and efficiency of RMNH services potentially contributing to the reduction of maternal and neonatal deaths. Addressing the challenges cited by participants, particularly the equipment for peer learning and practice, may increase the success of the CM program.
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Affiliation(s)
- Kahabi Isangula
- School of Nursing and Midwifery, Aga Khan University, Dar es Salaam, Tanzania
| | - Columba Mbekenga
- School of Nursing and Midwifery, Aga Khan University, Dar es Salaam, Tanzania
| | - Tumbwene Mwansisya
- School of Nursing and Midwifery, Aga Khan University, Dar es Salaam, Tanzania
| | - Loveluck Mwasha
- School of Nursing and Midwifery, Aga Khan University, Dar es Salaam, Tanzania
| | - Lucy Kisaka
- School of Nursing and Midwifery, Aga Khan University, Dar es Salaam, Tanzania
| | | | - David Siso
- Aga Khan Development Network, Dar es Salaam, Tanzania
| | | | - Secilia Mrema
- Regional Reproductive and Child Health Coordinator, Mwanza, Tanzania
| | - Eunice Pallangyo
- School of Nursing and Midwifery, Aga Khan University, Dar es Salaam, Tanzania
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Kuster A, Lee KA, Sligar K. Quality Improvement Project to Increase Postpartum Clinic Visits for Publicly Insured Women. J Obstet Gynecol Neonatal Nurs 2022; 51:313-323. [PMID: 35240046 DOI: 10.1016/j.jogn.2022.01.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/24/2022] [Indexed: 10/19/2022] Open
Abstract
OBJECTIVE To increase the percentage of women who attend postpartum visits and decrease the number of days to the first postpartum visit by implementing a scheduling change. DESIGN Quality improvement project. SETTING/LOCAL PROBLEM A small nurse practitioner maternity care clinic in an academic health center at which only 74% of the women who attended two or more prenatal visits attended postpartum clinic visits. PARTICIPANTS A diverse sample of 25 publicly insured women who gave birth during the 5-month implementation period. INTERVENTION/MEASUREMENTS We added a 2- to 3-week postpartum appointment to our standard 6-week postpartum appointment. The measurable outcomes were the percentage of women who attended postpartum clinic visits and the number of days to the first postpartum visit. RESULTS During the first 4 months of the 5-month project implementation phase, 14 of the 20 (70%) women who gave birth attended postpartum visits. The attendance at postpartum visits in the last month of the project was 100% (all five women). Days to first postpartum visit decreased from a mean of 40.7 in the baseline year to a mean of 21.8 by the last month of project implementation. CONCLUSION Despite the small scope of this project, our outcomes support continuing the practice of scheduling an earlier postpartum clinic appointment. The timing for when to preschedule postpartum appointments and contextual factors, such as the availability and use of telehealth technology and COVID-19 pandemic challenges, should be considered when implementing similar projects in other settings.
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Mwansisya T, Mbekenga C, Isangula K, Mwasha L, Pallangyo E, Edwards G, Orwa J, Mantel M, Mugerwa M, Subi L, Mrema S, Siso D, Selestine E, Temmerman M. Translation and validation of Training Needs Analysis Questionnaire among reproductive, maternal and newborn health workers in Tanzania. BMC Health Serv Res 2021; 21:735. [PMID: 34303368 PMCID: PMC8310585 DOI: 10.1186/s12913-021-06686-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2020] [Accepted: 06/23/2021] [Indexed: 01/18/2023] Open
Abstract
Background Continuous professional development (CPD) has been reported to enhance healthcare workers’ knowledge and skills, improve retention and recruitment, improve the quality of patient care, and reduce patient mortality. Therefore, validated training needs assessment tools are important to facilitate the design of effective CPD programs. Methods A cross-sectional survey was conducted using self-administered questionnaires. Participants were healthcare workers in reproductive, maternal, and neonatal health (RMNH) from seven hospitals, 12 health centers, and 17 dispensaries in eight districts of Mwanza Region, Tanzania. The training needs analysis (TNA) tool that was used for data collection was adapted and translated into Kiswahili from English version of the Hennessy-Hicks’ Training Need Analysis Questionnaire (TNAQ). Results In total, 153 healthcare workers participated in this study. Most participants were female 83 % (n = 127), and 76 % (n = 115) were nurses. The average age was 39 years, and the mean duration working in RMNH was 7.9 years. The reliability of the adapted TNAQ was 0.954. Assessment of construct validity indicated that the comparative fit index was equal to 1. Conclusions The adapted TNAQ appears to be reliable and valid for identifying professional training needs among healthcare workers in RMNH settings in Mwanza Region, Tanzania. Further studies with larger sample sizes are needed to test the use of the TNAQ in broader healthcare systems and settings.
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Affiliation(s)
- Tumbwene Mwansisya
- School of Nursing and Midwifery, the Aga Khan University, Dar es Salaam, Tanzania.
| | - Columba Mbekenga
- School of Nursing and Midwifery, the Aga Khan University, Dar es Salaam, Tanzania
| | - Kahabi Isangula
- School of Nursing and Midwifery, the Aga Khan University, Dar es Salaam, Tanzania
| | - Loveluck Mwasha
- School of Nursing and Midwifery, the Aga Khan University, Dar es Salaam, Tanzania
| | - Eunice Pallangyo
- School of Nursing and Midwifery, the Aga Khan University, Dar es Salaam, Tanzania
| | - Grace Edwards
- School of Nursing and Midwifery, the Aga Khan University, Kampala, Uganda
| | - James Orwa
- Department of Population Health, the Aga Khan University, Nairobi, Kenya
| | - Michaela Mantel
- Department of Population Health, the Aga Khan University, Nairobi, Kenya
| | | | - Leonard Subi
- Community Development, Ministry of Health, Gender, Elderly and Children, Dodoma, Tanzania
| | - Secilia Mrema
- Regional Reproductive and Child Health Coordinator, Mwanza, Tanzania
| | - David Siso
- Aga Khan Foundation, Dar es Salaam, Tanzania
| | | | - Marleen Temmerman
- Department of Population Health, the Aga Khan University, Nairobi, Kenya
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Bintabara D, Basinda N. Twelve-year persistence of inequalities in antenatal care utilisation among women in Tanzania: a decomposition analysis of population-based cross-sectional surveys. BMJ Open 2021; 11:e040450. [PMID: 33879479 PMCID: PMC8061846 DOI: 10.1136/bmjopen-2020-040450] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVE This study was undertaken to assess the trend and contributors of socioeconomic inequalities in antenatal care (ANC) utilisation among women of reproductive age in Tanzania from 2004 to 2016. DESIGN Population-based cross-sectional surveys. SETTING This study analysed nationally representative data for women of reproductive age obtained from the 2004-2016 Tanzania Demographic Health Surveys. PRIMARY OUTCOME MEASURE The outcome variables analysed in this study are: (1) attendance of ANC and (2) accessing adequate antenatal care. ANALYTICAL METHODS The concentration curve and the concentration index were used to measure socioeconomic inequality in attending and accessing adequate ANC. The concentration index was decomposed to identify the factors explaining the observed socioeconomic inequality of these two outcomes. RESULTS The concentration index for attending at least four ANC visits increased from 0.169 in 2004 to 0.243 in 2016 (p<0.01). Similarly, for accessing adequate care, the index increased from 0.147 in 2004 to 0.355 in 2016 (p<0.01). This indicates the significant increase in socioeconomic inequalities (favouring wealthier women) for these two outcomes over time. Furthermore, the results show that wealth status was the largest contributor to inequality in both attending at least four visits (71%, 50% and 70%) and accessing adequate ANC (50%, 42% and 51%) in 2004, 2010 and 2016, respectively, in favour of wealthier women (p<0.05). The other contributors to socioeconomic inequalities in ANC utilisation were maternal education and type of residence. CONCLUSION Over the 12 years of surveys, there was no reduction in socioeconomic inequalities in ANC utilisation in Tanzania. Therefore, the efforts of achieving universal health coverage should focus on reducing wealth-related inequality and improving women's education from poor households.
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Affiliation(s)
| | - Namanya Basinda
- Department of Public Health, Catholic University of Health and Allied Sciences, Mwanza, Tanzania
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Orwa J, Gatimu SM, Mantel M, Luchters S, Mugerwa MA, Brownie S, Subi L, Mrema S, Nyaga L, Edwards G, Mwasha L, Isangula K, Selestine E, Jadavji S, Pell R, Mbekenga C, Temmerman M. Birth preparedness and complication readiness among women of reproductive age in Kenya and Tanzania: a community-based cross-sectional survey. BMC Pregnancy Childbirth 2020; 20:636. [PMID: 33076869 PMCID: PMC7574438 DOI: 10.1186/s12884-020-03329-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2020] [Accepted: 10/09/2020] [Indexed: 12/28/2022] Open
Abstract
Background Delayed health-seeking continues to contribute to preventable maternal and neonatal deaths in low resource countries. Some of the strategies to avoid the delay include early preparation for the birth and detection of danger signs. We aimed to assess the level of practice and factors associated with birth preparedness and complication readiness (BPCR) in Kenya and Tanzania. Methods We conducted community-based multi-stage cross-sectional surveys in Kilifi and Kisii counties in Kenya and Mwanza region in Tanzania and included women who delivered two years preceding the survey (2016–2017). A woman who mentioned at least three out of five BPCR components was considered well-prepared. Bivariate and multivariable proportional odds model were used to determine the factors associated with the BPCR. The STROBE guidelines for cross-sectional studies informed the design and reporting of this study. Results Only 11.4% (59/519) and 7.6% (31/409) of women were well-prepared for birth and its complications in Kenya and Tanzania, respectively, while 39.7 and 30.6% were unprepared, respectively. Level of education (primary: adjusted odds ratio (aOR): 1.59, 95% CI: 1.14–2.20, secondary: aOR: 2.24, 95% CI: 1.39–3.59), delivery within health facility (aOR: 1.63, 95% CI: 1.15–2.29), good knowledge of danger signs during pregnancy (aOR: 1.28, 95% CI: 0.80–2.04), labour and childbirth (aOR: 1.57, 95% CI: 0.93–2.67), postpartum (aOR: 2.69, 95% CI: 1.24–5.79), and antenatal care were associated with BPCR (aOR: 1.42, 95% CI: 1.13–1.78). Conclusion Overall, most pregnant women were not prepared for birth and its complications in Kilifi, Kisii and Mwanza region. Improving level of education, creating awareness on danger signs during preconception, pregnancy, childbirth, and postpartum period, and encouraging antenatal care and skilled birth care among women and their male partners/families are recommended strategies to promote BPCR practices and contribute to improved pregnancy outcomes in women and newborns.
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Affiliation(s)
- James Orwa
- Centre of Excellence Women and Child Health/MERL, Aga Khan University, P. O. Box 30270-00010, Nairobi, Kenya. .,Department of Population Health, Aga Khan University, Nairobi, Kenya.
| | | | - Michaela Mantel
- Centre of Excellence Women and Child Health/MERL, Aga Khan University, P. O. Box 30270-00010, Nairobi, Kenya.,Department of Population Health, Aga Khan University, Nairobi, Kenya.,Department of Obstetrics and Gynaecology, Aga Khan University, Nairobi, Kenya
| | - Stanley Luchters
- Department of Population Health, Aga Khan University, Nairobi, Kenya.,Department of Public Health and Primary Care, Ghent University, Ghent, Belgium.,Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Australia.,Burnet Institute, Melbourne, Australia
| | | | - Sharon Brownie
- Centre for Health & Social Practice, Waikato Institute of Technology (Wintec), Hamilton, New Zealand.,School of Medicine, Griffith University, Brisbane, QLD, Australia.,Green Templeton College, Oxford University, Oxford, UK
| | - Leonard Subi
- Ministry of Health, Community Development, Gender, Elderly and Children, Dar es Salaam, Tanzania
| | - Secilia Mrema
- Regional Reproductive and Child Health Office, Region, Mwanza, Tanzania
| | - Lucy Nyaga
- Centre of Excellence Women and Child Health/MERL, Aga Khan University, P. O. Box 30270-00010, Nairobi, Kenya
| | - Grace Edwards
- School of Nursing and Midwifery, Aga Khan University, Kampala, Uganda
| | - Loveluck Mwasha
- School of Nursing and Midwifery, Aga Khan University, Dar es Salaam, Tanzania
| | - Kahabi Isangula
- School of Nursing and Midwifery, Aga Khan University, Dar es Salaam, Tanzania
| | | | | | | | - Columba Mbekenga
- School of Nursing and Midwifery, Aga Khan University, Dar es Salaam, Tanzania
| | - Marleen Temmerman
- Centre of Excellence Women and Child Health/MERL, Aga Khan University, P. O. Box 30270-00010, Nairobi, Kenya.,Department of Obstetrics and Gynaecology, Aga Khan University, Nairobi, Kenya.,Department of Public Health and Primary Care, Ghent University, Ghent, Belgium
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