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Kuwawenaruwa A, Mollel H, Machonchoryo JM, Margini F, Jaribu J, Binyaruka P. A political economy analysis of strengthening health information system in Tanzania. BMC Med Inform Decis Mak 2023; 23:245. [PMID: 37904121 PMCID: PMC10617168 DOI: 10.1186/s12911-023-02319-9] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2022] [Accepted: 09/30/2023] [Indexed: 11/01/2023] Open
Abstract
BACKGROUND Many countries' health systems are implementing reforms to improve the functioning and performance of the Health Management Information System (HMIS) to facilitate evidence-based decisions for delivery of accessible and quality health services. However, in some countries such efforts and initiatives have led to a complex HMIS ecosystem characterized by multiple and fragmented sub-systems. We undertook an in-depth analysis of the HMIS ecosystem in Tanzania to inform the ongoing initiatives, by understanding the relationship and power differences among stakeholders, as well as drivers and barriers to HMIS investment and strengthening. METHODOLOGY This was a qualitative research method incorporating data collection through document review and key informant interviews guided by political economy analytical framework. A total of 17 key informant interviews were conducted between April and May 2022. A thematic content analysis was used during data analysis. RESULTS Good relationship between the government and stakeholders dealing/supporting HMIS ecosystem was noted as there are technical working groups which brings stakeholders together to discuss and harmonize HMIS activities. The 'need for the data' has been the driving force toward investment in the HMIS ecosystem. The analysis showed that the government is the main stakeholder within the HMIS ecosystem and responsible for identifying the needs for improvement and has the power to approve or reject systems which are not in line with the government priority as stipulated with the HMIS investment roadmap/strategy. Moreover, partners with long relationship are powerful in influencing HMIS investment decision-making compared to those who are recently coming to support. It was further noted shortage of staff with technical competence, inadequate financial resources, and the development of fact that some of the existing systems have not been developed to their full capacity and have hindered the whole systems' integration and interoperability exercise of ensuring integration and interoperability of the systems. CONCLUSION A need-based assessment of staff capacity at the sub-national level is equally important to identify available capabilities and the knowledge gap to strengthen the HMIS ecosystem. Strong coordination of the ideas and resources intended to strengthen the HMIS ecosystem would help to reduce fragmentation. In addition, there is a need to mobilize resources within and outside the country to facilitate the integration and interoperability process smoothly.
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Affiliation(s)
- August Kuwawenaruwa
- Ifakara Health Institute, Plot 463, Kiko Avenue Mikocheni, P.O. Box 78 373, Dar es Salaam, Tanzania.
| | - Henry Mollel
- Mzumbe University, P.O Box 1, Mzumbe, Morogoro, Tanzania
| | | | | | | | - Peter Binyaruka
- Ifakara Health Institute, Plot 463, Kiko Avenue Mikocheni, P.O. Box 78 373, Dar es Salaam, Tanzania
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Day LT, Ruysen H, Gordeev VS, Gore-Langton GR, Boggs D, Cousens S, Moxon SG, Blencowe H, Baschieri A, Rahman AE, Tahsina T, Zaman SB, Hossain T, Rahman QSU, Ameen S, El Arifeen S, KC A, Shrestha SK, KC NP, Singh D, Jha AK, Jha B, Rana N, Basnet O, Joshi E, Paudel A, Shrestha PR, Jha D, Bastola RC, Ghimire JJ, Paudel R, Salim N, Shamb D, Manji K, Shabani J, Shirima K, Mkopi N, Mrisho M, Manzi F, Jaribu J, Kija E, Assenga E, Kisenge R, Pembe A, Hanson C, Mbaruku G, Masanja H, Amouzou A, Azim T, Jackson D, Kabuteni TJ, Mathai M, Monet JP, Moran A, Ram P, Rawlins B, Sæbø JI, Serbanescu F, Vaz L, Zaka N, Lawn JE. “Every Newborn-BIRTH” protocol: observational study validating indicators for coverage and quality of maternal and newborn health care in Bangladesh, Nepal and Tanzania. J Glob Health 2019; 9:010902. [DOI: 10.7189/jogh.09.010902] [Citation(s) in RCA: 35] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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Day LT, Ruysen H, Gordeev VS, Gore-Langton GR, Boggs D, Cousens S, Moxon SG, Blencowe H, Baschieri A, Rahman AE, Tahsina T, Zaman SB, Hossain T, Rahman QSU, Ameen S, El Arifeen S, Kc A, Shrestha SK, Kc NP, Singh D, Jha AK, Jha B, Rana N, Basnet O, Joshi E, Paudel A, Shrestha PR, Jha D, Bastola RC, Ghimire JJ, Paudel R, Salim N, Shamb D, Manji K, Shabani J, Shirima K, Mkopi N, Mrisho M, Manzi F, Jaribu J, Kija E, Assenga E, Kisenge R, Pembe A, Hanson C, Mbaruku G, Masanja H, Amouzou A, Azim T, Jackson D, Kabuteni TJ, Mathai M, Monet JP, Moran A, Ram P, Rawlins B, Sæbø JI, Serbanescu F, Vaz L, Zaka N, Lawn JE. " Every Newborn-BIRTH" protocol: observational study validating indicators for coverage and quality of maternal and newborn health care in Bangladesh, Nepal and Tanzania. J Glob Health 2019. [PMID: 30863542 PMCID: PMC6406050 DOI: 10.7189/jogh.09.01902] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023] Open
Abstract
Background To achieve Sustainable Development Goals and Universal Health Coverage, programmatic data are essential. The Every Newborn Action Plan, agreed by all United Nations member states and >80 development partners, includes an ambitious Measurement Improvement Roadmap. Quality of care at birth is prioritised by both Every Newborn and Ending Preventable Maternal Mortality strategies, hence metrics need to advance from health service contact alone, to content of care. As facility births increase, monitoring using routine facility data in DHIS2 has potential, yet validation research has mainly focussed on maternal recall surveys. The Every Newborn – Birth Indicators Research Tracking in Hospitals (EN-BIRTH) study aims to validate selected newborn and maternal indicators for routine tracking of coverage and quality of facility-based care for use at district, national and global levels. Methods EN-BIRTH is an observational study including >20 000 facility births in three countries (Tanzania, Bangladesh and Nepal) to validate selected indicators. Direct clinical observation will be compared with facility register data and a pre-discharge maternal recall survey for indicators including: uterotonic administration, immediate newborn care, neonatal resuscitation and Kangaroo mother care. Indicators including neonatal infection management and antenatal corticosteroid administration, which cannot be easily observed, will be validated using inpatient records. Trained clinical observers in Labour/Delivery ward, Operation theatre, and Kangaroo mother care ward/areas will collect data using a tablet-based customised data capturing application. Sensitivity will be calculated for numerators of all indicators and specificity for those numerators with adequate information. Other objectives include comparison of denominator options (ie, true target population or surrogates) and quality of care analyses, especially regarding intervention timing. Barriers and enablers to routine recording and data usage will be assessed by data flow assessments, quantitative and qualitative analyses. Conclusions To our knowledge, this is the first large, multi-country study validating facility-based routine data compared to direct observation for maternal and newborn care, designed to provide evidence to inform selection of a core list of indicators recommended for inclusion in national DHIS2. Availability and use of such data are fundamental to drive progress towards ending the annual 5.5 million preventable stillbirths, maternal and newborn deaths.
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Affiliation(s)
- Louise T Day
- Joint first authors.,Maternal, Adolescent, Reproductive & Child Health (MARCH) Centre, London School of Hygiene &Tropical Medicine (LSHTM), London, UK
| | - Harriet Ruysen
- Joint first authors.,Maternal, Adolescent, Reproductive & Child Health (MARCH) Centre, London School of Hygiene &Tropical Medicine (LSHTM), London, UK
| | - Vladimir S Gordeev
- Maternal, Adolescent, Reproductive & Child Health (MARCH) Centre, London School of Hygiene &Tropical Medicine (LSHTM), London, UK
| | - Georgia R Gore-Langton
- Maternal, Adolescent, Reproductive & Child Health (MARCH) Centre, London School of Hygiene &Tropical Medicine (LSHTM), London, UK
| | - Dorothy Boggs
- Maternal, Adolescent, Reproductive & Child Health (MARCH) Centre, London School of Hygiene &Tropical Medicine (LSHTM), London, UK
| | - Simon Cousens
- Maternal, Adolescent, Reproductive & Child Health (MARCH) Centre, London School of Hygiene &Tropical Medicine (LSHTM), London, UK
| | - Sarah G Moxon
- Maternal, Adolescent, Reproductive & Child Health (MARCH) Centre, London School of Hygiene &Tropical Medicine (LSHTM), London, UK
| | - Hannah Blencowe
- Maternal, Adolescent, Reproductive & Child Health (MARCH) Centre, London School of Hygiene &Tropical Medicine (LSHTM), London, UK
| | - Angela Baschieri
- Maternal, Adolescent, Reproductive & Child Health (MARCH) Centre, London School of Hygiene &Tropical Medicine (LSHTM), London, UK
| | - Ahmed Ehsanur Rahman
- Maternal and Child Health Division, International Centre for Diarrhoeal Disease Research, Bangladesh (iccdr,b), Dhaka, Bangladesh
| | - Tazeen Tahsina
- Maternal and Child Health Division, International Centre for Diarrhoeal Disease Research, Bangladesh (iccdr,b), Dhaka, Bangladesh
| | - Sojib Bin Zaman
- Maternal and Child Health Division, International Centre for Diarrhoeal Disease Research, Bangladesh (iccdr,b), Dhaka, Bangladesh
| | - Tanvir Hossain
- Maternal and Child Health Division, International Centre for Diarrhoeal Disease Research, Bangladesh (iccdr,b), Dhaka, Bangladesh
| | - Qazi Sadeq-Ur Rahman
- Maternal and Child Health Division, International Centre for Diarrhoeal Disease Research, Bangladesh (iccdr,b), Dhaka, Bangladesh
| | - Shafiqul Ameen
- Maternal and Child Health Division, International Centre for Diarrhoeal Disease Research, Bangladesh (iccdr,b), Dhaka, Bangladesh
| | - Shams El Arifeen
- Maternal and Child Health Division, International Centre for Diarrhoeal Disease Research, Bangladesh (iccdr,b), Dhaka, Bangladesh
| | - Ashish Kc
- Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
| | | | - Naresh P Kc
- Department of Health Services, Ministry of Health, Kathmandu, Nepal
| | - Dela Singh
- Pokhara Academy of Health Science, Pokhara Ranipauwa, Nepal
| | | | - Bijay Jha
- Nepal Health Research Council, Kathmandu, Nepal
| | - Nisha Rana
- Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
| | | | | | | | | | - Deepak Jha
- Department of Health Services, Ministry of Health, Kathmandu, Nepal
| | | | | | | | - Nahya Salim
- Department of Paediatrics and Child Health, Muhimbili University of Health and Allied Sciences, Dar Es Salaam, Tanzania
| | - Donat Shamb
- Department of Health Systems, Impact Evaluation and Policy, Ifakara Health Institute, Dar es Salaam, Tanzania
| | - Karim Manji
- Department of Paediatrics and Child Health, Muhimbili University of Health and Allied Sciences, Dar Es Salaam, Tanzania
| | - Josephine Shabani
- Department of Health Systems, Impact Evaluation and Policy, Ifakara Health Institute, Dar es Salaam, Tanzania
| | - Kizito Shirima
- Department of Health Systems, Impact Evaluation and Policy, Ifakara Health Institute, Dar es Salaam, Tanzania
| | - Namala Mkopi
- Department of Paediatrics and Child Health, Muhimbili University of Health and Allied Sciences, Dar Es Salaam, Tanzania
| | - Mwifadhi Mrisho
- Department of Health Systems, Impact Evaluation and Policy, Ifakara Health Institute, Dar es Salaam, Tanzania
| | - Fatuma Manzi
- Department of Health Systems, Impact Evaluation and Policy, Ifakara Health Institute, Dar es Salaam, Tanzania
| | - Jennie Jaribu
- Department of Health Systems, Impact Evaluation and Policy, Ifakara Health Institute, Dar es Salaam, Tanzania
| | - Edward Kija
- Department of Paediatrics and Child Health, Muhimbili University of Health and Allied Sciences, Dar Es Salaam, Tanzania
| | - Evelyne Assenga
- Department of Paediatrics and Child Health, Muhimbili University of Health and Allied Sciences, Dar Es Salaam, Tanzania
| | - Rodrick Kisenge
- Department of Paediatrics and Child Health, Muhimbili University of Health and Allied Sciences, Dar Es Salaam, Tanzania
| | - Andrea Pembe
- Department of Paediatrics and Child Health, Muhimbili University of Health and Allied Sciences, Dar Es Salaam, Tanzania
| | - Claudia Hanson
- Public Health Sciences - Global Health - Health Systems and Policy, Karolinska Institutet, Stockholm, Sweden
| | - Godfrey Mbaruku
- Department of Health Systems, Impact Evaluation and Policy, Ifakara Health Institute, Dar es Salaam, Tanzania.,Deceased 2 September 2018
| | - Honorati Masanja
- Department of Health Systems, Impact Evaluation and Policy, Ifakara Health Institute, Dar es Salaam, Tanzania
| | - Agbessi Amouzou
- Institute for International Programs, Department of International Health, Johns Hopkins University, Baltimore, Maryland, USA
| | - Tariq Azim
- MEAUSRE Evaluation, University of North Carolina, North Carolina, USA
| | - Debra Jackson
- Knowledge Management & Implementation Research Unit, Health Section, UNICEF, New York, USA
| | | | - Matthews Mathai
- Centre for Maternal and Newborn Health, Liverpool School of Tropical Medicine, Liverpool, UK
| | | | - Allisyn Moran
- Department of Maternal, Newborn, Child and Adolescent Health, World Health Organization, Geneva, Switzerland
| | - Pavani Ram
- Office of Health, Infectious Disease and Nutrition, Bureau for Global Health, United States Agency for International Development, Washington, DC, USA
| | | | - Johan Ivar Sæbø
- Department for Informatics, University of Oslo, Oslo, Norway
| | - Florina Serbanescu
- Division of Reproductive Health, Centres for Disease Control and Prevention (CDC), Atlanta, Georgia, USA
| | - Lara Vaz
- Save the Children, Washington, DC, USA
| | - Nabila Zaka
- Knowledge Management & Implementation Research Unit, Health Section, UNICEF, New York, USA
| | - Joy E Lawn
- Maternal, Adolescent, Reproductive & Child Health (MARCH) Centre, London School of Hygiene &Tropical Medicine (LSHTM), London, UK
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Abstract
Purpose The purpose of this paper is to describe a quality improvement (QI) intervention in primary health facilities providing childbirth care in rural Southern Tanzania. Design/methodology/approach A QI collaborative model involving district managers and health facility staff was piloted for 6 months in 4 health facilities in Mtwara Rural district and implemented for 18 months in 23 primary health facilities in Ruangwa district. The model brings together healthcare providers from different health facilities in interactive workshops by: applying QI methods to generate and test change ideas in their own facilities; using local data to monitor improvement and decision making; and health facility supervision visits by project and district mentors. The topics for improving childbirth were deliveries and partographs. Findings Median monthly deliveries increased in 4 months from 38 (IQR 37-40) to 65 (IQR 53-71) in Mtwara Rural district, and in 17 months in Ruangwa district from 110 (IQR 103-125) to 161 (IQR 148-174). In Ruangwa health facilities, the women for whom partographs were used to monitor labour progress increased from 10 to 57 per cent in 17 months. Research limitations/implications The time for QI innovation, testing and implementation phases was limited, and the study only looked at trends. The outcomes were limited to process rather than health outcome measures. Originality/value Healthcare providers became confident in the QI method through engagement, generating and testing their own change ideas, and observing improvements. The findings suggest that implementing a QI initiative is feasible in rural, low-income settings.
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Affiliation(s)
- Jennie Jaribu
- Epidemiology and Public Health, Swiss Tropical and Public Health Institute, Basel, Switzerland
| | - Suzanne Penfold
- Department of Disease Control, London School of Hygiene and Tropical Medicine, London, UK
| | | | - Fatuma Manzi
- Ifakara Health Institute, Dar es Salaam, Tanzania
| | - Joanna Schellenberg
- Department of Disease Control and Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, UK
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Jaribu J, Penfold S, Manzi F, Schellenberg J, Pfeiffer C. Improving institutional childbirth services in rural Southern Tanzania: a qualitative study of healthcare workers' perspective. BMJ Open 2016; 6:e010317. [PMID: 27660313 PMCID: PMC5051329 DOI: 10.1136/bmjopen-2015-010317] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVE To describe health workers' perceptions of a quality improvement (QI) intervention that focused on improving institutional childbirth services in primary health facilities in Southern Tanzania. DESIGN A qualitative design was applied using in-depth interviews with health workers. SETTING This study involved the Ruangwa District Reproductive and Child Health Department, 11 dispensaries and 2 health centres in rural Southern Tanzania. PARTICIPANTS 4 clinical officers, 5 nurses and 6 medical attendants from different health facilities were interviewed. RESULTS The healthcare providers reported that the QI intervention improved their skills, capacity and confidence in providing counselling and use of a partograph during labour. The face-to-face QI workshops, used as a platform to refresh their knowledge on maternal and newborn health and QI methods, facilitated peer learning, networking and standardisation of care provision. The onsite follow-up visits were favoured by healthcare providers because they gave the opportunity to get immediate help, learn how to perform tasks in practice and be reminded of what they had learnt. Implementation of parallel interventions focusing on similar indicators was mentioned as a challenge that led to duplication of work in terms of data collection and reporting. District supervisors involved in the intervention showed interest in taking over the implementation; however, funding remained a major obstacle. CONCLUSIONS Healthcare workers highlighted the usefulness of applying a QI approach to improve maternal and newborn health in rural settings. QI programmes need careful coordination at district level in order to reduce duplication of work.
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Affiliation(s)
- Jennie Jaribu
- Swiss Tropical and Public Health Institute, Basel, Switzerland
- Basel University, Basel, Switzerland
- Ifakara Health Institute, Dar es Salaam, United Republic of Tanzania
| | | | - Fatuma Manzi
- Ifakara Health Institute, Dar es Salaam, United Republic of Tanzania
| | | | - Constanze Pfeiffer
- Swiss Tropical and Public Health Institute, Basel, Switzerland
- Basel University, Basel, Switzerland
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Hanson C, Manzi F, Mkumbo E, Shirima K, Penfold S, Hill Z, Shamba D, Jaribu J, Hamisi Y, Soremekun S, Cousens S, Marchant T, Mshinda H, Schellenberg D, Tanner M, Schellenberg J. Effectiveness of a Home-Based Counselling Strategy on Neonatal Care and Survival: A Cluster-Randomised Trial in Six Districts of Rural Southern Tanzania. PLoS Med 2015; 12:e1001881. [PMID: 26418813 PMCID: PMC4587813 DOI: 10.1371/journal.pmed.1001881] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2015] [Accepted: 08/20/2015] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND We report a cluster-randomised trial of a home-based counselling strategy, designed for large-scale implementation, in a population of 1.2 million people in rural southern Tanzania. We hypothesised that the strategy would improve neonatal survival by around 15%. METHODS AND FINDINGS In 2010 we trained 824 female volunteers to make three home visits to women and their families during pregnancy and two visits to them in the first few days of the infant's life in 65 wards, selected randomly from all 132 wards in six districts in Mtwara and Lindi regions, constituting typical rural areas in Southern Tanzania. The remaining wards were comparison areas. Participants were not blinded to the intervention. The primary analysis was an intention-to-treat analysis comparing the neonatal mortality (day 0-27) per 1,000 live births in intervention and comparison wards based on a representative survey in 185,000 households in 2013 with a response rate of 90%. We included 24,381 and 23,307 live births between July 2010 and June 2013 and 7,823 and 7,555 live births in the last year in intervention and comparison wards, respectively. We also compared changes in neonatal mortality and newborn care practices in intervention and comparison wards using baseline census data from 2007 including 225,000 households and 22,243 births in five of the six intervention districts. Amongst the 7,823 women with a live birth in the year prior to survey in intervention wards, 59% and 41% received at least one volunteer visit during pregnancy and postpartum, respectively. Neonatal mortality reduced from 35.0 to 30.5 deaths per 1,000 live births between 2007 and 2013 in the five districts, respectively. There was no evidence of an impact of the intervention on neonatal survival (odds ratio [OR] 1.1, 95% confidence interval [CI] 0.9-1.2, p = 0.339). Newborn care practices reported by mothers were better in intervention than in comparison wards, including immediate breastfeeding (42% of 7,287 versus 35% of 7,008, OR 1.4, CI 1.3-1.6, p < 0.001), feeding only breast milk for the first 3 d (90% of 7,557 versus 79% of 7,307, OR 2.2, 95% CI 1.8-2.7, p < 0.001), and clean hands for home delivery (92% of 1,351 versus 88% of 1,799, OR 1.5, 95% CI 1.0-2.3, p = 0.033). Facility delivery improved dramatically in both groups from 41% of 22,243 in 2007 and was 82% of 7,820 versus 75% of 7,553 (OR 1.5, 95% CI 1.2-2.0, p = 0.002) in intervention and comparison wards in 2013. Methodological limitations include our inability to rule out some degree of leakage of the intervention into the comparison areas and response bias for newborn care behaviours. CONCLUSION Neonatal mortality remained high despite better care practices and childbirth in facilities becoming common. Public health action to improve neonatal survival in this setting should include a focus on improving the quality of facility-based childbirth care. TRIAL REGISTRATION ClinicalTrials.gov NCT01022788.
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Affiliation(s)
- Claudia Hanson
- Faculty of Infectious & Tropical Disease, London School of Hygiene & Tropical Medicine, London, United Kingdom
- Department of Public Health Sciences, Global health - Health systems and policy, Karolinska Institutet, Stockholm, Sweden
| | - Fatuma Manzi
- Ifakara Health Institute, Dar es Salaam, Tanzania
| | | | | | - Suzanne Penfold
- Faculty of Infectious & Tropical Disease, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Zelee Hill
- Institute of Global Health, University College London, London, United Kingdom
| | - Donat Shamba
- Ifakara Health Institute, Dar es Salaam, Tanzania
| | | | - Yuna Hamisi
- Ifakara Health Institute, Dar es Salaam, Tanzania
| | - Seyi Soremekun
- Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Simon Cousens
- Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Tanya Marchant
- Faculty of Infectious & Tropical Disease, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Hassan Mshinda
- Ifakara Health Institute, Dar es Salaam, Tanzania
- Tanzania Commission for Science and Technology (COSTECH), Dar es Salaam, Tanzania
| | - David Schellenberg
- Faculty of Infectious & Tropical Disease, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Marcel Tanner
- Swiss Tropical & Public Health Institute, Basel, Switzerland
- University of Basel, Basel, Switzerland
| | - Joanna Schellenberg
- Faculty of Infectious & Tropical Disease, London School of Hygiene & Tropical Medicine, London, United Kingdom
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Marchant T, Penfold S, Mkumbo E, Shamba D, Jaribu J, Manzi F, Schellenberg J. The reliability of a newborn foot length measurement tool used by community volunteers to identify low birth weight or premature babies born at home in southern Tanzania. BMC Public Health 2014; 14:859. [PMID: 25142865 PMCID: PMC4152587 DOI: 10.1186/1471-2458-14-859] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2013] [Accepted: 08/11/2014] [Indexed: 11/20/2022] Open
Abstract
Background Low birthweight babies need extra care, and families need to know whether their newborn is low birthweight in settings where many births are at home and weighing scales are largely absent. In the context of a trial to improve newborn health in southern Tanzania, a counselling card was developed that incorporated a newborn foot length measurement tool to screen newborns for low birth weight and prematurity. This was used by community volunteers at home visits and shows a scale picture of a newborn foot with markers for a ‘short foot’ (<8 cm). The tool built on previous hospital based research that found newborn foot length <8 cm to have sensitivity and specificity to identify low birthweight (<2500 g) of 87% and 60% respectively. Methods Reliability of the tool used by community volunteers to identify newborns with short feet was tested. Between July-December 2010 a researcher accompanied volunteers to the homes of babies younger than seven days and conducted paired measures of newborn foot length using the counselling card tool and using a plastic ruler. Intra-method reliability of foot length measures was assessed using kappa scores, and differences between measurers were analysed using Bland and Altman plots. Results 142 paired measures were conducted. The kappa statistic for the foot length tool to classify newborns as having small feet indicated that it was moderately reliable when applied by volunteers, with a kappa score of 0.53 (95% confidence interval 0.40 – 0.66) . Examination of differences revealed that community volunteers systematically underestimated the length of newborn feet compared to the researcher (mean difference −0.26 cm (95% confidence interval −0.31—0.22), thus overestimating the number of newborns needing extra care. Conclusions The newborn foot length tool used by community volunteers to identify small babies born at home was moderately reliable in southern Tanzania where a large number of births occur at home and scales are not available. Newborn foot length is not the best anthropometric proxy for birthweight but was simple to implement at home in the first days of life when the risk of newborn death is highest.
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Affiliation(s)
- Tanya Marchant
- Faculty of Infectious and Tropical Disease, London School of Hygiene and Tropical Medicine, Keppel St, London WC1E 7HT, UK.
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Penfold S, Manzi F, Mkumbo E, Temu S, Jaribu J, Shamba DD, Mshinda H, Cousens S, Marchant T, Tanner M, Schellenberg D, Armstrong Schellenberg J. Effect of home-based counselling on newborn care practices in southern Tanzania one year after implementation: a cluster-randomised controlled trial. BMC Pediatr 2014; 14:187. [PMID: 25052850 PMCID: PMC4115472 DOI: 10.1186/1471-2431-14-187] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2014] [Accepted: 07/14/2014] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND In Sub-Saharan Africa over one million newborns die annually. We developed a sustainable and scalable home-based counselling intervention for delivery by community volunteers in rural southern Tanzania to improve newborn care practices and survival. Here we report the effect on newborn care practices one year after full implementation. METHODS All 132 wards in the 6-district study area were randomised to intervention or comparison groups. Starting in 2010, in intervention areas trained volunteers made home visits during pregnancy and after childbirth to promote recommended newborn care practices including hygiene, breastfeeding and identification and extra care for low birth weight babies. In 2011, in a representative sample of 5,240 households, we asked women who had given birth in the previous year both about counselling visits and their childbirth and newborn care practices. RESULTS Four of 14 newborn care practices were more commonly reported in intervention than comparison areas: delaying the baby's first bath by at least six hours (81% versus 68%, OR 2.0 (95% CI 1.2-3.4)), exclusive breastfeeding in the three days after birth (83% versus 71%, OR 1.9 (95% CI 1.3-2.9)), putting nothing on the cord (87% versus 70%, OR 2.8 (95% CI 1.7-4.6)), and, for home births, tying the cord with a clean thread (69% versus 39%, OR 3.4 (95% CI 1.5-7.5)). For other behaviours there was little evidence of differences in reported practices between intervention and comparison areas including childbirth in a health facility or with a skilled attendant, thermal care practices, breastfeeding within an hour of birth and, for home births, the birth attendant having clean hands, cutting the cord with a clean blade and birth preparedness activities. CONCLUSIONS A home-based counselling strategy using volunteers and designed for scale-up can improve newborn care behaviours in rural communities of southern Tanzania. Further research is needed to evaluate if, and at what cost, these gains will lead to improved newborn survival. TRIAL REGISTRATION Trial Registration Number NCT01022788 (http://www.clinicaltrials.gov, 2009).
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Affiliation(s)
- Suzanne Penfold
- London School of Hygiene and Tropical Medicine, Keppel Street, London, UK
| | - Fatuma Manzi
- Ifakara Health Institute, Dar es Salaam, Tanzania
| | | | - Silas Temu
- Ifakara Health Institute, Dar es Salaam, Tanzania
| | - Jennie Jaribu
- London School of Hygiene and Tropical Medicine, Keppel Street, London, UK,Ifakara Health Institute, Dar es Salaam, Tanzania,Swiss Tropical and Public Health Institute, Basel, Switzerland,University of Basel, Basel, Switzerland
| | | | - Hassan Mshinda
- Tanzania Commission for Science and Technology, Dar es Salaam, Tanzania
| | - Simon Cousens
- London School of Hygiene and Tropical Medicine, Keppel Street, London, UK
| | - Tanya Marchant
- London School of Hygiene and Tropical Medicine, Keppel Street, London, UK
| | - Marcel Tanner
- Swiss Tropical and Public Health Institute, Basel, Switzerland,University of Basel, Basel, Switzerland
| | - David Schellenberg
- London School of Hygiene and Tropical Medicine, Keppel Street, London, UK
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Penfold S, Shamba D, Hanson C, Jaribu J, Manzi F, Marchant T, Tanner M, Ramsey K, Schellenberg D, Schellenberg JA. Staff experiences of providing maternity services in rural southern Tanzania - a focus on equipment, drug and supply issues. BMC Health Serv Res 2013; 13:61. [PMID: 23410228 PMCID: PMC3599073 DOI: 10.1186/1472-6963-13-61] [Citation(s) in RCA: 68] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2012] [Accepted: 02/11/2013] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The poor maintenance of equipment and inadequate supplies of drugs and other items contribute to the low quality of maternity services often found in rural settings in low- and middle-income countries, and raise the risk of adverse patient outcomes through delaying care provision. We aim to describe staff experiences of providing maternal and neonatal care in rural health facilities in Southern Tanzania, focusing on issues related to equipment, drugs and supplies. METHODS Focus group discussions and in-depth interviews were conducted with different staff cadres from all facility levels in order to explore experiences and views of providing maternity care in the context of poorly maintained equipment, and insufficient drugs and other supplies. A facility survey quantified the availability of relevant items. RESULTS The facility survey, which found many missing or broken items and frequent stock outs, corroborated staff reports of providing care in the context of missing or broken care items. Staff reported increased workloads, reduced morale, difficulties in providing optimal maternity care, and carrying out procedures with potential health risks to themselves as a result. CONCLUSIONS Inadequately stocked and equipped facilities compromise the health system's ability to reduce maternal and neonatal mortality and morbidity by affecting staff personally and professionally, which hinders the provision of timely and appropriate interventions. Improving stock control and maintaining equipment could benefit mothers and babies, not only through removing restrictions to the availability of care, but also through improving staff working conditions.
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Affiliation(s)
- Suzanne Penfold
- Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, UK
| | - Donat Shamba
- Ifakara Health Institute, Dar es Salaam, Tanzania
| | - Claudia Hanson
- Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, UK
- Division of Global Health, Karolinska Institutet, Stockholm, Sweden
| | | | - Fatuma Manzi
- Ifakara Health Institute, Dar es Salaam, Tanzania
| | - Tanya Marchant
- Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, UK
| | - Marcel Tanner
- Swiss Tropical and Public Health Institute, Basel, Switzerland and University of Basel, Basel, Switzerland
| | - Kate Ramsey
- Ifakara Health Institute, Dar es Salaam, Tanzania
| | - David Schellenberg
- Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, UK
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Marchant T, Jaribu J, Penfold S, Tanner M, Armstrong Schellenberg J. Measuring newborn foot length to identify small babies in need of extra care: a cross sectional hospital based study with community follow-up in Tanzania. BMC Public Health 2010; 10:624. [PMID: 20959008 PMCID: PMC2975655 DOI: 10.1186/1471-2458-10-624] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2010] [Accepted: 10/19/2010] [Indexed: 12/03/2022] Open
Abstract
Background Neonatal mortality because of low birth weight or prematurity remains high in many developing country settings. This research aimed to estimate the sensitivity and specificity, and the positive and negative predictive values of newborn foot length to identify babies who are low birth weight or premature and in need of extra care in a rural African setting. Methods A cross-sectional study of newborn babies in hospital, with community follow-up on the fifth day of life, was carried out between 13 July and 16 October 2009 in southern Tanzania. Foot length, birth weight and gestational age were estimated on the first day and foot length remeasured on the fifth day of life. Results In hospital 529 babies were recruited and measured within 24 hours of birth, 183 of whom were also followed-up at home on the fifth day. Day one foot length <7 cm at birth was 75% sensitive (95%CI 36-100) and 99% specific (95%CI 97-99) to identify very small babies (birth weight <1500 grams); foot length <8 cm had sensitivity and specificity of 87% (95%CI 79-94) and 60% (95%CI 55-64) to identify those with low birth weight (<2500 grams), and 93% (95%CI 82-99) and 58% (95%CI 53-62) to identify those born premature (<37 weeks). Mean foot length on the first day was 7.8 cm (standard deviation 0.47); the mean difference between first and fifth day foot lengths was 0.1 cm (standard deviation 0.3): foot length measured on or before the fifth day of life identified more than three-quarters of babies who were born low birth weight. Conclusion Measurement of newborn foot length for home births in resource poor settings has the potential to be used by birth attendants, community volunteers or parents as a screening tool to identify low birth weight or premature newborns in order that they can receive targeted interventions for improved survival
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Affiliation(s)
- Tanya Marchant
- Department of Global Health and Development, LSHTM, 15-17 Tavistock Place, London, UK.
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