A prospective area-based study of the outcome of pregnancy in rural Tanzania

Prevalence and adverse outcomes of twin pregnancy in Eastern Africa: a systematic review and meta-analysis

INTRODUCTION

Multiple pregnancies are much more common today than they were in the past. Twin pregnancies occur in about 4% of pregnancies in Africa. Adverse pregnancy outcome was more common in twin pregnancy than in singleton pregnancy. There is no pooled evidence on the burden and adverse pregnancy outcome of twin pregnancy in eastern Africa. Thus, this systematic review and meta-analysis were conducted to assess the prevalence and adverse pregnancy outcomes of twin pregnancies.

METHODS

This systematic review and meta-analysis covers published and unpublished studies searched from different databases (PubMed, CINAHL (EBSCO), EMBASE, DOAJ, Web of Sciences, MEDLINE, Cochrane Library, SCOPUS, Google Scholar, and Google search). Finally, 34 studies were included in this systematic review and meta-analysis. JBI checklist was used to assess the quality of included papers. Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were used. Data synthesis and statistical analysis were conducted using STATA Version 14 software. Heterogeneity and publication bias were assessed. A forest plot was used to present the pooled prevalence using the random effect model.

RESULTS

The prevalence of twin pregnancy in eastern Africa was 3% [95% CI: 2, 3]. The adverse pregnancy outcomes like neonatal intensive care unit admission (78%), low birth weight (44%), low APGAR score (33%), prematurity (32%), stillbirth (30%), neonatal mortality (12%) and maternal complications like hypertensive disorder of pregnancy (25%), postpartum hemorrhage (7%), Cesarean section (37%), premature rupture of membrane (12%) and maternal mortality are more common among twin pregnancy than singleton pregnancy.

CONCLUSION

One in every 33 children born a twin in east Africa; admission to neonatal intensive care unit, low birth weight, low APGAR score, prematurity, stillbirth, neonatal mortality and maternal complications are its associated adverse birth outcomes. Since twin pregnancy is a high-risk pregnancy, special care is needed during pregnancy, labor and delivery to reduce adverse pregnancy outcomes.

Magnitude of maternal and neonatal mortality in Tanzania: A systematic review

BACKGROUND

Maternal and neonatal mortality remains a serious challenge in Tanzania. Progress is tracked through maternal mortality ratios (MMR) and neonatal mortality rates (NMR), yet robust national data on these outcomes is difficult and expensive to ascertain, and mask wide variation.

SEARCH STRATEGY

We searched EMBASE, MEDLINE, Popline, and EBSCO online databases, basing search terms on ("maternal" OR "neonatal") AND ("mortality" OR "cause of death") AND "Tanzania."

SELECTION CRITERIA

Nationally representative or population representative from the subnational context were eligible, providing NMR, MMR, or numbers of maternal deaths or early neonatal deaths or neonatal deaths and live births.

DATA COLLECTION AND ANALYSIS

Data were extracted on study context, time period, number of deaths and live births, definition of maternal and neonatal death, study design, and completeness and representativeness of data. NMR and MMR were extracted or calculated and study quality was assessed. Nationally representative data were compared with modelled national data from international agencies.

MAIN RESULTS

2107 records were screened yielding 21 maternal mortality and 15 neonatal mortality datasets. There were high mortality levels with wide subnational MMR and NMR variation. National survey data differed from the modelled estimates, with wide uncertainty ranges.

CONCLUSION

Subnational data quality was generally poor with no observable trends and geographical clustering across several regions. Combined MMR and NMR reporting is uncommon. Modelled national estimates lack precision and are complex to interpret. Results suggest that aggregate national data are inadequate for policy generation and progress monitoring. We recommend strengthening of vital registration and Health Management Information Systems with complementary use of process indicators, for improved monitoring of, and accountability for maternal and newborn health.

Achieving progress in maternal and neonatal health through integrated and comprehensive healthcare services - experiences from a programme in northern Tanzania

BACKGROUND

An integrated and comprehensive hospital/community based health programme is presented, aimed at reducing maternal and child mortality and morbidity. It is run as part of a general programme of health care at a rural hospital situated in northern Tanzania. The purpose was through using research and statistics from the programme area, to illustrate how a hospital-based programme with a vision of integrated healthcare may have contributed to the lower figures on mortality found in the area. Such an approach may be of interest to policy makers, in relation to the global strategy that is now developed in order to meet the MDGs 4 and 5.

PROGRAMME SETTING

The hospital provides reproductive and child health services, PMTCT-plus, comprehensive emergency obstetric care, ambulance, radio and transport services, paediatric care, an HIV/AIDS programme, and a generalised healthcare service to a population of approximately 500 000.

PROGRAMME DESCRIPTION AND OUTCOMES

We describe these services and their potential contribution to the reduction of the maternal and neonatal mortality ratios in the study area. Several studies from this area have showed a lower maternal mortality and neonatal mortality ratio compared to other studies from Tanzania and the national estimates. Many donor-funded programmes focusing on maternal and child health are vertical in their framework. However, the hospital, being the dominant supplier of health services in its catchment area, has maintained a horizontal approach through a comprehensive care programme. The total cost of the comprehensive hospital programme described is 3.2 million USD per year, corresponding to 6.4 USD per capita.

CONCLUSION

Considering the relatively low cost of a comprehensive hospital programme including outreach services and the lower mortality ratios found in the catchment area of the hospital, we argue that donor funds should be used for supporting horizontal programmes aimed at comprehensive healthcare services. Through a strengthening of the collaboration between government and voluntary agency facilities, with clinical, preventive and managerial capabilities of the health facilities, the programmes will have a more sustainable impact and will achieve greater progress in the reduction of maternal and neonatal mortality, as opposed to vertical and segregated programmes that currently are commonly adopted for averting maternal and child deaths. Thus, we conclude that horizontal and comprehensive services of the type described in this article should be considered as a prerequisite for sustainable health care delivery at all policy and decision-making levels of the local, national and international health care delivery pyramid.

The importance of preterm births for peri- and neonatal mortality in rural Malawi

Peri- and neonatal mortality remain high in developing countries, especially in sub-Saharan Africa. In the present study, we quantified and identified the most important predictors of early mortality in rural Malawi. Data were obtained from a community-based cohort of 795 pregnant women and their 813 fetuses, followed prospectively from mid-pregnancy. In this group, peri- and neonatal mortality rates were 65.3 deaths per 1000 births and 37.0 deaths per 1000 live births respectively. When controlled for month of birth, maternal age and selected socio-economic variables, preterm birth was the strongest independent predictor of both peri- and neonatal mortality (adjusted odds ratios 9.6 for perinatal and 11.0 for neonatal mortality; 95% confidence intervals: [4.4, 21.0] and [3.7, 32.7] respectively). Weaker risk factors for mortality included a maternal history of stillbirth and abnormal delivery. Preterm delivery was associated with primiparity and peripheral malaria parasitaemia of the mother, and it accounted for 65% of the population-attributable risk for perinatal and 68% of the neonatal mortality. Successful intervention programmes to reduce peri- and neonatal mortality in Malawi have to include strategies to predict and prevent prematurity.

Retrospective follow-up of maternal deaths and their associated risk factors in a rural district of Tanzania

OBJECTIVE

To determine the maternal mortality rate in a rural district of Tanzania and to measure the incidence of causes of maternal mortality, the presence of risk factors and the relationship with social and demographic factors.

METHOD

From January to December 1993 a retrospective recording of maternal deaths was completed using verbal autopsy and networking.

RESULTS

A total of 76 deaths were found which is equivalent to a maternal mortality ratio of 961 per 100,000 live births for this 12-month period of time. The leading causes of death were postpartum haemorrhage with retained placenta, anaemia, postpartum haemorrhage without retained placenta, AIDS complex and obstructed labour (in descending order of frequency). Maternal deaths were seen irrespective of group factors such as access to a main road, presence of antenatal risk factors and contact with health care personnel or a nearby facility before death. Mortality was also present both in home and hospital deliveries (excluding hospital referrals). Antenatal care had been received by 97.2% of the mothers who died after the second trimester. The referral rate even in the presence of a known antenatal risk factor was 34.6%. Patient compliance to the referral was only 44.4%. Mothers and their families followed strong cultural beliefs even when they were detrimental to the mother's health. Maternal deaths were proportionately higher among women > 40 who were also gravid > or = 5, but there was no significant increase in deaths in women < 19 years of age.

CONCLUSION

Effective antenatal care, appropriate emergency treatment of complications, access to transportation and competent referral level care with adequate equipment encompass the most effective answers to reduction of maternal deaths at a district level.