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Dominico S, Serbanescu F, Mwakatundu N, Kasanga MG, Chaote P, Subi L, Maro G, Prasad N, Ruiz A, Mongo W, Schmidt K, Lobis S. A Comprehensive Approach to Improving Emergency Obstetric and Newborn Care in Kigoma, Tanzania. Glob Health Sci Pract 2022; 10:GHSP-D-21-00485. [PMID: 35487553 PMCID: PMC9053146 DOI: 10.9745/ghsp-d-21-00485] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/26/2021] [Accepted: 03/02/2022] [Indexed: 11/17/2022]
Abstract
Efforts to increase the availability and utilization of high-quality emergency obstetric and newborn care and routine delivery care services in Kigoma were successful and subsequently contributed to significant reductions in maternal and perinatal mortality in the region. Introduction: To address high levels of maternal mortality in Kigoma, Tanzania, stakeholders increased women's access to high-quality comprehensive emergency obstetric and newborn care (EmONC) by decentralizing services from hospitals to health centers where EmONC was delivered mostly by associate clinicians and nurses. To ensure that women used services, implementers worked to continuously improve and sustain quality of care while creating demand. Methods: Program evaluation included periodic health facility assessments, pregnancy outcome monitoring, and enhanced maternal mortality detection region-wide in program- and nonprogram-supported health facilities. Results: Between 2013 and 2018, the average number of lifesaving interventions performed per facility increased from 2.8 to 4.7. The increase was higher in program-supported than nonprogram-supported health centers and dispensaries. The institutional delivery rate increased from 49% to 85%; the greatest increase occurred through using health centers (15% to 25%) and dispensaries (21% to 46%). The number of cesarean deliveries almost doubled, and the population cesarean delivery rate increased from 2.6% to 4.5%. Met need for emergency obstetric care increased from 44% to 61% while the direct obstetric case fatality rate declined from 1.8% to 1.4%. The institutional maternal mortality ratio across all health facilities declined from 303 to 174 deaths per 100,000 live births. The total stillbirth rate declined from 26.7 to 12.8 per 1,000 births. The predischarge neonatal mortality rate declined from 10.7 to 7.6 per 1,000 live births. Changes in case fatality rate and maternal mortality were driven by project-supported facilities. Changes in neonatal mortality varied depending on facility type and program support status. Conclusion: Decentralizing high-quality comprehensive EmONC delivered mostly by associate clinicians and nurses led to significant improvements in the availability and utilization of lifesaving care at birth in Kigoma. Dedicated efforts to sustain high-quality EmONC along with supplemental programmatic components contributed to the reduction of maternal and perinatal mortality.
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Affiliation(s)
| | - Florina Serbanescu
- U.S. Centers for Disease Control and Prevention, Division of Reproductive Health, Atlanta, GA, USA.
| | | | | | - Paul Chaote
- President's Office Regional Administration and Local Government, Health Social Welfare and Nutrition Division, Dodoma, Tanzania
| | - Leonard Subi
- Ministry of Health, Community Development, Gender, Elderly and Children, Dodoma, Tanzania
| | | | | | - Alicia Ruiz
- U.S. Centers for Disease Control and Prevention, Division of Reproductive Health, Atlanta, GA, USA
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Prasad N, Mwakatundu N, Dominico S, Masako P, Mongo W, Mwanshemele Y, Maro G, Subi L, Chaote P, Rusibamayila N, Ruiz A, Schmidt K, Kasanga MG, Lobis S, Serbanescu F. Improving Maternal and Reproductive Health in Kigoma, Tanzania: A 13-Year Initiative. Glob Health Sci Pract 2022; 10:GHSP-D-21-00484. [PMID: 35487559 PMCID: PMC9053157 DOI: 10.9745/ghsp-d-21-00484] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/26/2021] [Accepted: 03/02/2022] [Indexed: 11/15/2022]
Abstract
The 13-year Program to Reduce Maternal Deaths in Tanzania employed multifaceted maternal, newborn, and reproductive health interventions that contributed to increasing the availability and utilization of high-quality obstetric and family planning services and reducing maternal and perinatal mortality in Kigoma. The Program to Reduce Maternal Deaths in Tanzania was a 13-year (2006–2019) effort in the Kigoma region that evolved over 3 phases to improve and sustain the availability of, access to, and demand for high-quality maternal and reproductive health care services. The Program intended to bring high-quality care closer to more communities. Cutting across the Program was the routine collection of monitoring and evaluation data. The Program achieved significant reductions in maternal and perinatal mortality, a significant increase in the modern contraceptive prevalence rate, and a significant decline in the unmet need for contraception. By 2017, it was apparent that the Program was on track to meet or surpass many of the targets established by the Government of Tanzania. Over the following 2-plus years, efforts to sustain Program interventions intensified. In April 2019, the Program fully transitioned to Government of Tanzania oversight. Four key lessons were learned during implementation that are relevant to governments, donors, and implementing organizations working to reduce maternal mortality: (1) multistakeholder partnerships are critical; (2) demand creation for services, while critical, must rest on a foundation of well-functioning and high-quality clinical services; (3) it is imperative to not only collect robust monitoring and evaluation data, but to be responsive in real time to what the data reveal; and, (4) it is necessary to develop a deliberate sustainability strategy from the start. The Program in Kigoma demonstrates that decentralizing high-quality maternal and reproductive health services in remote, low-resource settings is both feasible and effective and should be considered in places with similar contexts. By embedding the Program in the existing health system, and through efforts to build local capacity, the improvements seen in Kigoma are likely to be sustained. Follow-up evaluations are planned, providing an opportunity to more directly assess sustainability.
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Affiliation(s)
| | | | | | | | | | | | | | - Leonard Subi
- Ministry of Health, Community Development, Gender, Elderly and Children, Dodoma, Tanzania
| | - Paul Chaote
- President's Office Regional Administration and Local Government, Health Social Welfare and Nutrition Division, Dodoma, Tanzania
| | - Neema Rusibamayila
- Ministry of Health, Community Development, Gender, Elderly and Children, Dodoma, Tanzania
| | - Alicia Ruiz
- U.S. Centers for Disease Control and Prevention, Division of Reproductive Health, Atlanta, USA
| | | | | | | | - Florina Serbanescu
- U.S. Centers for Disease Control and Prevention, Division of Reproductive Health, Atlanta, USA.
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Smith R, Ruiz A, Westercamp M, Maro G, Serbanescu F. 731. Puerperal Sepsis Among Women with In-facility Births in Western Tanzania. Open Forum Infect Dis 2021. [PMCID: PMC8643737 DOI: 10.1093/ofid/ofab466.928] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Background Puerperal sepsis is an important cause of maternal mortality worldwide. As access to emergency obstetric services expands in resource-limited settings, rapid recognition and treatment of sepsis, and prevention of nosocomial infections that might lead to sepsis, is critical. We describe puerperal sepsis cases among women with in-facility births in the Kigoma region of Tanzania. Methods Demographic, obstetric history, pregnancy complication and outcome, as well as mortality data were collected for women who delivered in hospitals, health centers and dispensaries in the Kigoma region, Tanzania 2016 – 2018. Up to 3 maternal complications were recorded as free text. Puerperal sepsis included women where ‘sepsis’ was recorded as a complication during hospitalization. We calculated rates of puerperal sepsis and completed a descriptive analysis of patients. Results 203,604 women delivered infants in 197 participating facilities during the data collection period. Of these, 2228 (1.1%) had sepsis recorded, for an overall rate of 10.9 sepsis cases per 1000 deliveries. Although 48% of births occurred in dispensaries, sepsis complications were reported almost exclusively in hospitals and health centers (37.7 and 10.3 per 1000 deliveries, respectively). Sepsis rates varied across individual facilities, from 15.5 to 45.2 cases per 1000 deliveries in hospitals and 0 to 38.6 cases per 1000 deliveries in health centers. Women who developed sepsis had a median age of 25 (IQR 22 – 30) years and 1113 (56%) were nulliparous. 1763 (90%) of women who had sepsis delivered by caesarian delivery. Obstructed labor (827; 42%) was a common co-complication of sepsis; obstetric hemorrhage and uterine rupture were seen in 93 (5%) and 77 (4%) women with sepsis, respectively. 49 women with sepsis (3%) died prior to hospital discharge. Stillbirths and pre-discharge neonatal deaths complicated 107 (5%) and 74 (4%) deliveries to women with sepsis. Conclusion In the Kigoma region of Tanzania puerperal sepsis frequently occurs in women with obstructed labor and caesarian delivery. Further evaluation of both facility-level and individual factors that contribute to the incidence of sepsis in this population, particularly those related to invasive procedures, is critical for early recognition and prevention. issue Disclosures All Authors: No reported disclosures
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Affiliation(s)
- Rachel Smith
- Centers for Disease Control and Prevention, Decatur, GA
| | | | | | - Godson Maro
- Bloomberg Philanthropies, Dar es Salaam, Dar es Salaam, Tanzania
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Kraft JM, Serbanescu F, Schmitz MM, Mwanshemele Y, Ruiz C AG, Maro G, Chaote P. Factors Associated with Contraceptive Use in Sub-Saharan Africa. J Womens Health (Larchmt) 2021; 31:447-457. [PMID: 34129385 PMCID: PMC8972023 DOI: 10.1089/jwh.2020.8984] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Background: Globally 10% of women have an unmet need for contraception, with higher rates in sub-Saharan Africa. Programs to improve family planning (FP) outcomes require data on how service characteristics (e.g., geographic access, quality) and women's characteristics are associated with contraceptive use. Materials and Methods: We combined data from health facility assessments (2018 and 2019) and a population-based regional household survey (2018) of married and in-union women ages 15–49 in the Kigoma Region of Tanzania. We assessed the associations between contraceptive use and service (i.e., distance, methods available, personnel) and women's (e.g., demographic characteristics, fertility experiences and intentions, attitudes toward FP) characteristics. Results: In this largely rural sample (n = 4,372), 21.7% of women used modern reversible contraceptive methods. Most variables were associated with contraceptive use in bivariate analyses. In multivariate analyses, access to services located <2 km of one's home that offered five methods (adjusted odds ratio [aOR] = 1.57, confidence interval [CI] = 1.18–2.10) and had basic amenities (aOR = 1.66, CI = 1.24–2.2) increased the odds of contraceptive use. Among individual variables, believing that FP benefits the family (aOR = 3.65, CI = 2.18–6.11) and believing that contraception is safe (aOR = 2.48, CI = 1.92–3.20) and effective (aOR = 3.59, CI = 2.63–4.90) had strong associations with contraceptive use. Conclusions: Both service and individual characteristics were associated with contraceptive use, suggesting the importance of coordination between efforts to improve access to services and social and behavior change interventions that address motivations, knowledge, and attitudes toward FP.
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Affiliation(s)
- Joan Marie Kraft
- Division of Reproductive Health, United States Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Florina Serbanescu
- Division of Reproductive Health, United States Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Michelle M Schmitz
- Division of Reproductive Health, United States Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | | | - Alicia G Ruiz C
- Division of Reproductive Health, United States Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | | | - Paul Chaote
- Health Social Welfare and Nutrition Division, President's Office Regional Administration and Local Government, Dar es Salaam, Tanzania
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Young MR, Morof D, Lathrop E, Haddad L, Blanton C, Maro G, Serbanescu F. Beyond adequate: Factors associated with quality of antenatal care in western Tanzania. Int J Gynaecol Obstet 2020; 151:431-437. [PMID: 32799345 DOI: 10.1002/ijgo.13349] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2020] [Revised: 04/28/2020] [Accepted: 08/13/2020] [Indexed: 11/09/2022]
Abstract
OBJECTIVE To determine quality of antenatal care (ANC). Most literature focuses on ANC attendance and services. Less is known about quality of care (QoC). METHOD Data were analyzed from the 2016 Kigoma Reproductive Health Survey, a population-based survey of reproductive-aged women. Women with singleton term live births were included and principal component analysis (PCA) was used to create an ANC quality index using linear combinations of weights of the first principal component. Nineteen variables were selected for the index. The index was then used to assign a QoC score for each woman and linear regression used to identify factors associated with receiving higher QoC. RESULTS A total of 3178 women received some ANC. Variables that explained the most variance in the QoC index included: gave urine (0.35); gave blood (0.34); and blood pressure measured (0.30). In multivariable linear regression, factors associated with higher QoC included: ANC at a hospital (versus dispensary); older age; higher level of education; working outside the home; higher socioeconomic status; and having lower parity. CONCLUSION Using PCA methods, several basic components of ANC including maternal physical assessment were identified as important indicators of quality. This approach provides an affordable and effective means of evaluating ANC programs.
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Affiliation(s)
- Marisa R Young
- Department of Gynecology and Obstetrics, Emory University, Atlanta, GA, USA
| | - Diane Morof
- Division of Global HIV/AIDS and Tuberculosis, U.S. Centers for Disease Control and Prevention, Pretoria, South Africa
| | - Eva Lathrop
- Department of Gynecology and Obstetrics, Emory University, Atlanta, GA, USA
| | - Lisa Haddad
- Department of Gynecology and Obstetrics, Emory University, Atlanta, GA, USA
| | - Curtis Blanton
- Division of Global Health Protection, U.S. Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Godson Maro
- Bloomberg Philanthropies, Dar es Salaam, Tanzania
| | - Florina Serbanescu
- Division of Reproductive Health, U.S. Centers for Disease Control and Prevention, Atlanta, GA, USA
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Fukunaga R, Morof D, Blanton C, Ruiz A, Maro G, Serbanescu F. Factors associated with local herb use during pregnancy and labor among women in Kigoma region, Tanzania, 2014-2016. BMC Pregnancy Childbirth 2020; 20:122. [PMID: 32085731 PMCID: PMC7035699 DOI: 10.1186/s12884-020-2735-3] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2019] [Accepted: 01/09/2020] [Indexed: 11/11/2022] Open
Abstract
Background Despite research suggesting an association between certain herb use during pregnancy and delivery and postnatal complications, herbs are still commonly used among pregnant women in sub-Sahara Africa (SSA). This study examines the factors and characteristics of women using local herbs during pregnancy and/or labor, and the associations between local herb use and postnatal complications in Kigoma, Tanzania. Methods We analyzed data from the 2016 Kigoma Tanzania Reproductive Health Survey (RHS), a regionally representative, population-based survey of reproductive age women (15–49 years). We included information on each woman’s most recent pregnancy resulting in a live birth during January 2014–September 2016. We calculated weighted prevalence estimates and used multivariable logistic regression to calculate adjusted odds ratios (aOR) and 95% confidence intervals (CI) for factors associated with use of local herbs during pregnancy and/or labor, as well as factors associated with postnatal complications. Results Of 3530 women, 10.9% (CI: 9.0–13.1) used local herbs during their last pregnancy and/or labor resulting in live birth. The most common reasons for taking local herbs included stomach pain (42.9%) and for the health of the child (25.5%). Adjusted odds of local herb use was higher for women reporting a home versus facility-based delivery (aOR: 1.6, CI: 1.1–2.2), having one versus three or more prior live births (aOR: 1.8, CI: 1.4–2.4), and having a household income in the lowest versus the highest wealth tercile (aOR: 1.4, CI: 1.1–1.9). Adjusted odds of postnatal complications were higher among women who used local herbs versus those who did not (aOR: 1.5, CI: 1.2–1.9), had four or more antenatal care visits versus fewer (aOR: 1.4, CI: 1.2–1.2), and were aged 25–34 (aOR: 1.1, CI: 1.0–1.3) and 35–49 (aOR: 1.3, CI: 1.0–1.6) versus < 25 years. Conclusions About one in ten women in Kigoma used local herbs during their most recent pregnancy and/or labor and had a high risk of postnatal complications. Health providers may consider screening pregnant women for herb use during antenatal and delivery care as well as provide information about any known risks of complications from herb use.
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Affiliation(s)
- R Fukunaga
- Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia, USA. .,Epidemic Intelligence Service, Atlanta, Georgia, USA.
| | - D Morof
- Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia, USA.,United States Public Health Service, Atlanta, USA
| | - C Blanton
- Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - A Ruiz
- Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - G Maro
- Bloomberg Philanthropies, New York, New York, United States
| | - F Serbanescu
- Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
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Mengistu T, Berruti A, Krivelyova A, Swor M, Waite R, Maro G. Cost of providing emergency obstetric care in Tanzania's Kigoma region. Int J Health Plann Manage 2019; 34:e1510-e1519. [PMID: 31270861 DOI: 10.1002/hpm.2820] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2019] [Accepted: 05/15/2019] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND The provision of Emergency Obstetric and Neonatal Care (EmONC) is critical for reducing maternal mortality, yet little is known about the costs of EmONC services in developing countries. This study estimates these costs at six health facilities in Tanzania's Kigoma region. METHODS The study took a comprehensive programmatic approach considering all sources of financial and in-kind support over a 1-year period (1 July 2012 to 30 June 2013). Data were collected retrospectively and costs disaggregated by input, sources of support, programmatic activity, and patient type (nonsurgical, surgical patients, and among the latter patients undergoing caesarean sections). RESULTS The median per-patient cost across the six facilities was $290. Personnel and equipment purchases accounted for the largest proportions of the total costs, representing 32% and 28%, respectively. Average per-patient costs varied by patient type; cost per nonsurgical patient was $80, $258 for surgical patients and $426 for patients undergoing caesarean sections. Per-patient costs also varied substantially by facility type: mean per-patient cost at health centres was $620 compared with $169 at hospitals. CONCLUSIONS This study provides the first cost estimates of EmONC provision in Kigoma. These estimates could inform programme planning and highlight areas with potential scope for cost reductions.
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Affiliation(s)
- Tewodaj Mengistu
- Division of Global HIV and Tuberculosis, U.S. Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Andrés Berruti
- Division of Global HIV and Tuberculosis, U.S. Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | | | | | | | - Godson Maro
- Division of Global HIV and Tuberculosis, Centers for Disease Control and Prevention, Dar es Salaam, Tanzania
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Dynes MM, Twentyman E, Kelly L, Maro G, Msuya AA, Dominico S, Chaote P, Rusibamayila R, Serbanescu F. Patient and provider determinants for receipt of three dimensions of respectful maternity care in Kigoma Region, Tanzania-April-July, 2016. Reprod Health 2018; 15:41. [PMID: 29506559 PMCID: PMC5838967 DOI: 10.1186/s12978-018-0486-7] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2017] [Accepted: 02/25/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Lack of respectful maternity care (RMC) is increasingly recognized as a human rights issue and a key deterrent to women seeking facility-based deliveries. Ensuring facility-based RMC is essential for improving maternal and neonatal health, especially in sub-Saharan African countries where mortality and non-skilled delivery care remain high. Few studies have attempted to quantitatively identify patient and delivery factors associated with RMC, and none has modeled the influence of provider characteristics on RMC. This study aims to help fill these gaps through collection and analysis of interviews linked between clients and providers, allowing for description of both patient and provider characteristics and their association with receipt of RMC. METHODS We conducted cross-sectional surveys across 61 facilities in Kigoma Region, Tanzania, from April to July 2016. Measures of RMC were developed using 21-items in a Principal Components Analysis (PCA). We conducted multilevel, mixed effects generalized linear regression analyses on matched data from 249 providers and 935 post-delivery clients. The outcomes of interest included three dimensions of RMC-Friendliness/Comfort/Attention; Information/Consent; and Non-abuse/Kindness-developed from the first three components of PCA. Significance level was set at p < 0.05. RESULTS Significant client-level determinants for perceived Friendliness/Comfort/Attention RMC included age (30-39 versus 15-19 years: Coefficient [Coef] 0.63; 40-49 versus 15-19 years: Coef 0.79) and self-reported complications (reported complications versus did not: Coef - 0.41). Significant provider-level determinants included perception of fair pay (Perceives fair pay versus unfair pay: Coef 0.46), cadre (Nurses/midwives versus Clinicians: Coef - 0.46), and number of deliveries in the last month (11-20 versus < 11 deliveries: Coef - 0.35). Significant client-level determinants for Information/Consent RMC included labor companionship (Companion versus none: Coef 0.37) and religiosity (Attends services at least weekly versus less often: Coef - 0.31). Significant provider-level determinants included perception of fair pay (Perceives fair pay versus unfair: Coef 0.37), weekly work hours (Coef 0.01), and age (30-39 versus 20-29 years: Coef - 0.34; 40-49 versus 20-29 years: Coef - 0.58). Significant provider-level determinants for Non-abuse/Kindness RMC included the predictors of age (age 50+ versus 20-29 years: Coef 0.34) and access to electronic mentoring (Access to two mentoring types versus none: Coef 0.37). CONCLUSIONS These findings illustrate the value of including both client and provider information in the analysis of RMC. Strategies that address provider-level determinants of RMC (such as equitable pay, work environment, access to mentoring platforms) may improve RMC and subsequently address uptake of facility delivery.
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Affiliation(s)
- M. M. Dynes
- Centers for Disease Control and Prevention, Division of Reproductive Health, Atlanta, Georgia
| | - E. Twentyman
- Centers for Disease Control and Prevention, Division of Reproductive Health, Atlanta, Georgia
| | - L. Kelly
- Centers for Disease Control and Prevention, Division of Reproductive Health, Atlanta, Georgia
| | - G. Maro
- Bloomberg Philanthropies Tanzania, Kigoma, Tanzania
| | | | | | - P. Chaote
- Kigoma Region Ministry of Health, Kigoma, Tanzania
| | - R. Rusibamayila
- Ministry of Health Community Development Gender Elderly and Children, Dar es Salaam, Tanzania
| | - F. Serbanescu
- Centers for Disease Control and Prevention, Division of Reproductive Health, Atlanta, Georgia
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Chen YN, Schmitz MM, Serbanescu F, Dynes MM, Maro G, Kramer MR. Geographic Access Modeling of Emergency Obstetric and Neonatal Care in Kigoma Region, Tanzania: Transportation Schemes and Programmatic Implications. Glob Health Sci Pract 2017; 5:430-445. [PMID: 28839113 PMCID: PMC5620339 DOI: 10.9745/ghsp-d-17-00110] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/28/2017] [Accepted: 06/14/2017] [Indexed: 11/30/2022]
Abstract
32% of estimated live births in the region may not be able to reach emergency obstetric and neonatal care (EmONC) services within 2 hours in dry season, regardless of the type of transportation available. However, bicycles, motorcycles, and cars provide a significant increase in geographic accessibility in some areas. Achieving good access may require upgrading non-EmONC facilities to EmONC facilities in some districts while incorporating bicycles and motorcycles into the health transportation strategy in others. Background: Access to transportation is vital to reducing the travel time to emergency obstetric and neonatal care (EmONC) for managing complications and preventing adverse maternal and neonatal outcomes. This study examines the distribution of travel times to EmONC in Kigoma Region, Tanzania, using various transportation schemes, to estimate the proportion of live births (a proxy indicator of women needing delivery care) with poor geographic access to EmONC services. Methods: The 2014 Reproductive Health Survey of Kigoma Region identified 4 primary means of transportation used to travel to health facilities: walking, cycling, motorcycle, and 4-wheeled motor vehicle. A raster-based travel time model was used to map the 2-hour travel time catchment for each mode of transportation. Live birth density distributions were aggregated by travel time catchments, and by administrative council, to estimate the proportion of births with poor access. Results: Of all live births in Kigoma Region, 13% occurred in areas where women can reach EmONC facilities within 2 hours on foot, 33% in areas that can be reached within 2 hours only by motorized vehicles, and 32% where it is impossible to reach EmONC facilities within 2 hours. Over 50% of births in 3 of the 8 administrative councils had poor estimated access. In half the councils, births with poor access could be reduced to no higher than 12% if all female residents had access to motorized vehicles. Conclusion: Significant differences in geographic access to EmONC in Kigoma Region, Tanzania, were observed both by location and by primary transportation type. As most of the population may only have good EmONC access when using mechanized or motorized vehicles, bicycles and motorcycles should be incorporated into the health transportation strategy. Collaboration between private transportation sectors and obstetric service providers could improve access to EmONC services among most populations. In areas where residents may not access EmONC facilities within 2 hours regardless of the type of transportation used, upgrading EmONC capacity among nearby non-EmONC facilities may be required to improve accessibility.
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Affiliation(s)
- Yi No Chen
- Division of Reproductive Health, U.S. Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Michelle M Schmitz
- Division of Reproductive Health, U.S. Centers for Disease Control and Prevention, Atlanta, GA, USA.
| | - Florina Serbanescu
- Division of Reproductive Health, U.S. Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Michelle M Dynes
- Division of Reproductive Health, U.S. Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Godson Maro
- Bloomberg Philanthropies, Kigoma, United Republic of Tanzania
| | - Michael R Kramer
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, USA
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Topilko P, Maro G, Charnay P. [Boundary caps: a gating function at the CNS/PNS interface and a source of pluripotent PNS cells]. Rev Neurol (Paris) 2008; 163:1252-5. [PMID: 18355477 DOI: 10.1016/s0035-3787(07)78414-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Wang SJ, Lengeler C, Mtasiwa D, Mshana T, Manane L, Maro G, Tanner M. Rapid Urban Malaria Appraisal (RUMA) III: epidemiology of urban malaria in the municipality of Yopougon (Abidjan). Malar J 2006; 5:29. [PMID: 16584573 PMCID: PMC1489939 DOI: 10.1186/1475-2875-5-28] [Citation(s) in RCA: 43] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2005] [Accepted: 04/04/2006] [Indexed: 11/13/2022] Open
Abstract
Background The thinking behind malaria research and control strategies stems largely from experience gained in rural areas and needs to be adapted to the urban environment. Methods A rapid assessment of urban malaria was conducted in Dar es Salaam in June-August, 2003 using a standard Rapid Urban Malaria Appraisal (RUMA) methodology. This study was part of a multi-site study in sub-Saharan Africa supported by the Roll Back Malaria Partnership. Results Overall, around one million cases of malaria are reported every year by health facilities. However, school surveys in Dar es Salaam during a dry spell in 2003 showed that the prevalence of malaria parasites was low: 0.8%, 1.4%, 2.7% and 3.7% in the centre, intermediate, periphery and surrounding rural areas, respectively. Health facilities surveys showed that only 37/717 (5.2%) of presenting fever cases and 22/781 (2.8%) of non-fever cases were positive by blood slide. As a result, malaria-attributable fractions for fever episodes were low in all age groups and there was an important over-reporting of malaria cases. Increased malarial infection rates were seen in persons who travelled to rural areas within the past three months. A remarkably high coverage of insecticide-treated nets and a corresponding reduction in malarial infection risk were found. Conclusion The number of clinical malaria cases was much lower than routine reporting suggested. Improved malaria diagnosis and re-defined clinical guidelines are urgently required to avoid over-treatment with antimalarials.
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Affiliation(s)
- Shr-Jie Wang
- Swiss Tropical Institute, P.O. Box, CH-4002 Basel, Switzerland
| | | | - Deodatus Mtasiwa
- The Dar es Salaam Regional/City Medical Office of Health, P.O. Box 9084, Dar es Salaam, Tanzania
| | - Thomas Mshana
- Medical Laboratory Scientists Association of Tanzania, P.O. Box 65094, Dar es Salaam, Tanzania
| | - Lusinge Manane
- The Muhimbili University College of Health Sciences, P.O. Box 35091, Dar es Salaam, Tanzania
| | - Godson Maro
- The Muhimbili University College of Health Sciences, P.O. Box 35091, Dar es Salaam, Tanzania
| | - Marcel Tanner
- Swiss Tropical Institute, P.O. Box, CH-4002 Basel, Switzerland
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