Short inter-pregnancy interval: why is it still high among women in Dar es Salaam?

Introduction: in Tanzania, for the past decade, there has been a rising trend of women with short inter-pregnancy interval (IPI) (16% to 19%). Short IPI is associated with poor maternal and neonatal outcomes. We aimed to determine the factors associated with short IPI among women attending antenatal clinic (ANC) at Mnazi Mmoja Hospital, Dar es Salaam, Tanzania. Methods: a cross-sectional study was conducted in September 2018 at Mnazi Mmoja hospital among women receiving ante-natal care. A total of 530 women were included in the analysis. Analysis was conducted through SPSS version 24 computer program using descriptive analyses to determine the IPI and characteristics thereof, and logistic regression analysis to examine factors associated with IPI among pregnant women. Associations with a p-value < 0.05 were considered statistically significant. Results: twenty-two percent of the women attending ANC in Mnazi Mmoja hospital had short IPI. Short IPI was associated with young(<25years) age (AOR=2.67, 95% CI=1.23-5.79); non-use of a contraceptive method (AOR=2.05, 95%CI=1.22-3.45); breastfeeding for less than 6 months (AOR=3.45,95% CI=1.17-10.13) and having an antecedent dead child at the time of index conception (AOR=3.38,95% CI=1.15-9.93). Conclusion: about 1 in every 5 women attending ANC in Dar es Salaam had a short IPI. Addressing short IPI will complement the government´s efforts to improve maternal indicators in Tanzania and areas with similar contexts. Such efforts should emphasize in adherence to recommended infant feeding practices, women at a younger reproductive age group, those with a history of pregnancy loss, and strengthening contraception use among women of reproductive age

Predictors of fear of childbirth and depressive symptoms among pregnant women: a cross-sectional survey in Pwani region, Tanzania

Background: Many women experience fear of childbirth (FoB) and depressive symptoms (DS) during pregnancy, but little is known about FoB among Tanzanian women. The current study aimed to assess the prevalence of FoB and DS among pregnant women and determine predictors of each and both, focusing on sociodemographic and obstetric predictors. Methods: A cross-sectional study was conducted at six health facilities in two districts in Tanzania between 2018 and 2019. In total, 694 pregnant women with gestational age between 32 and 40weeks and expecting vaginal delivery were consecutively recruited and assessed for FoB and DS. We collected data through interviews using 6 and 4-points Likert Scale of the Wijma Delivery Expectancy Questionnaire Version A and Edinburgh Postnatal Depression Scale, respectively. Women who scored ≥66 and≥10 were categorised as having FoB and DS, respectively. We performed multivariable logistic regression to investigate the predictors of FoB and DS. Results: The prevalence rates of FoB and DS among pregnant women were 15.1 and 17.7%, respectively. FoB and DS were more likely in women aged above 30 years [Adjusted Odds Ratio (AOR) 6.29, 95%CI 1.43–27.84] and in single mothers (AOR 2.57, 95%CI 1.14–5.78). Women with secondary education and above (AOR 0.22, 95%CI 0.05–0.99) and those who had given birth previously (AOR 0.27, 95% CI 0.09–0.87) were less likely to have FoB in combination with DS Women who had previous obstetric complications, and those who did not receive any social support from male partners in previous childbirth were more likely to have FoB and DS. FoB was strongly associated with DS (AOR 3.42, 95%CI 2.12–5.53). DS only was more common in women who had inadequate income (AOR 2.35, 95%CI 1.38–3.99) or had previously experienced a perineal tear (AOR 2.32, 95%CI 1.31–4.08). Conclusions: Not having a formal education, having only primary education, being aged above 30 years, being single, being nulliparous, having experienced obstetric complications, and having a lack of social support from a male partner during previous pregnancy and childbirth were predictors of FoB and DS during pregnancy. FoB and DS were strongly associated with each other. It is vital to identify at-risk women early, to ofer support during pregnancy and childbirth

How communication can help women who experience a maternal near-miss: a qualitative study from Tanzania

Objectives This study aimed to explore experiences of communication as an element of quality of care, among women surviving a maternal near-miss event, thus women who nearly died but survived haemorrhage, or pre-eclampsia complication during pregnancy, childbirth or within 42 days of termination of pregnancy. Design A descriptive, phenomenological, qualitative study using semistructured interviews with women who survived a maternal near-miss in Southern Tanzania. Setting The participants were recruited from two selected hospitals in Mtwara Region, where women sought child birth care and developed near-miss condition. Participants Participants for this study were women who experienced and survived a maternal near-miss event and who had lived in the study area for at least 1 year. Women were recruited using an adapted version of the WHO criteria for maternal near-miss. Data collection We identified 16 women and were able to conduct 10 in-depth interviews with women at their homes, 4 weeks after they were discharged. The interviews were audiorecorded and transcribed and translated word for word from Kiswahili. Thematic analysis was used to identify emerging themes. Results Three major themes evolved: (1) Being informed about the care and interaction, (2) Being engaged and encouraged and (3) Being afraid to ask questions. The study highlighted that good communication with women during the provision of care helped women feel grateful, supported and cared for. Women who were unconscious during care were often not informed later of what happened. This created some negative feelings and anxiety. Conclusion This study highlights the importance of communication, and of being informed of what happened and why. Empathetic communication with sufficient explanation on what happened and why created trust among women-a positive finding which should encourage the development of consistent approaches to strengthen healthcare provider communication skills

A mixed-methods study of maternal health care utilisation in six referral hospitals in four sub-Saharan African countries before and during the COVID-19 pandemic

Introduction In sub-Saharan Africa, referral hospitals are important sources of key maternal health services, especially during a crisis such as the COVID-19 pandemic. This study prospectively assessed the effect of the COVID-19 pandemic on maternal health service utilisation in six large referral hospitals in Guinea, Nigeria, Tanzania and Uganda during the first year of the pandemic. Methods Mixed-methods design combining three data sources: (1) quantitative data based on routine antenatal, childbirth and postnatal care data collected March 2019–February 2021, (2) qualitative data from recurring rounds of semi-structured interviews conducted July 2020–February 2021 with 22 maternity skilled heath personnel exploring their perceptions of service utilisation and (3) timeline data of COVID-19 epidemiology, global, national and hospital-level events. Qualitative and quantitative data were analysed separately, framed based on the timeline analysis and triangulated when reporting. Results Three periods including a first wave, slow period and second wave were identified. Maternal health service utilisation was lower during the pandemic compared with the prepandemic year in all but one selected referral hospital. During the pandemic, service utilisation was particularly lower during the waves and higher or stable during the slow period. Fear of being infected in hospitals, lack of transportation, and even when available, high cost of transportation and service closures were key reasons affecting utilisation during the waves. However, community perception that the pandemic was over or insinuation by Government of the same appeared to stabilise use of referral hospitals for childbirth. Conclusion Utilisation of maternal health services across the continuum of care varied through the different periods and across countries. In crisis situations such as COVID-19, restrictions and service closures need to be implemented with consideration given to alternative options for women to access and use services. Information on measures put in place for safe hospital use should be communicated to women

A mixed-methods study of maternal health care utilisation in six referral hospitals in four sub-Saharan African countries before and during the COVID-19 pandemic.

INTRODUCTION: In sub-Saharan Africa, referral hospitals are important sources of key maternal health services, especially during a crisis such as the COVID-19 pandemic. This study prospectively assessed the effect of the COVID-19 pandemic on maternal health service utilisation in six large referral hospitals in Guinea, Nigeria, Tanzania and Uganda during the first year of the pandemic. METHODS: Mixed-methods design combining three data sources: (1) quantitative data based on routine antenatal, childbirth and postnatal care data collected March 2019-February 2021, (2) qualitative data from recurring rounds of semi-structured interviews conducted July 2020-February 2021 with 22 maternity skilled heath personnel exploring their perceptions of service utilisation and (3) timeline data of COVID-19 epidemiology, global, national and hospital-level events. Qualitative and quantitative data were analysed separately, framed based on the timeline analysis and triangulated when reporting. RESULTS: Three periods including a first wave, slow period and second wave were identified. Maternal health service utilisation was lower during the pandemic compared with the prepandemic year in all but one selected referral hospital. During the pandemic, service utilisation was particularly lower during the waves and higher or stable during the slow period. Fear of being infected in hospitals, lack of transportation, and even when available, high cost of transportation and service closures were key reasons affecting utilisation during the waves. However, community perception that the pandemic was over or insinuation by Government of the same appeared to stabilise use of referral hospitals for childbirth. CONCLUSION: Utilisation of maternal health services across the continuum of care varied through the different periods and across countries. In crisis situations such as COVID-19, restrictions and service closures need to be implemented with consideration given to alternative options for women to access and use services. Information on measures put in place for safe hospital use should be communicated to women

Quality Assessment and Monitoring of Maternal Referrals in Rural Tanzania

An efficient referral system is essential in providing access to emergency obstetric care at higher levels of care by supporting antenatal and delivery services in the primary level of care facilities (PLCF). The aim of this thesis was to assess community and health service factors affecting the quality of maternal referrals in rural Tanzania. Ten focus group discussions (FGDs) with health workers and community members were conducted to describe their perceptions on maternal referrals. Women (n=1118) were interviewed to determine awareness of obstetric danger signs and associated factors. Compliance with referral advice was analysed for 1538 women referred from PLCF. Counselling on danger signs and adherence to referral criteria was observed in 438 antenatal consultations. FGDs indicated that women had limited influence, especially on emergency referrals. The process of deciding to seek referral care considered the perception of seriousness and past experience of referral, access to transport, and the cost involved. Women had low awareness of danger signs of obstetric complications: higher years of schooling increased the likelihood of being aware of danger signs. Demographic risks accounted for 70% of referred women but less than half complied with the advice. Compliance was higher for historical obstetric risks, prenatal, natal, and postnatal complications groups. Few women were counselled on pregnancy danger signs and a significant number with ≥5 pregnancies and primigravidae <20 years were not informed of the risk factors. This thesis demonstrated a need for reviewing referral guidelines and an increase in supportive supervision for health workers counselling on obstetric danger signs to enhance acceptance of referrals advices. Women’s education should be given priority for increasing participation in decisions and becoming more aware of danger signs. Costs involved in maternal referrals can be relieved by improving family income, infrastructure, and alleviating the cost of referral through mobilising community transport and financial schemes

Quality Assessment and Monitoring of Maternal Referrals in Rural Tanzania

An efficient referral system is essential in providing access to emergency obstetric care at higher levels of care by supporting antenatal and delivery services in the primary level of care facilities (PLCF). The aim of this thesis was to assess community and health service factors affecting the quality of maternal referrals in rural Tanzania. Ten focus group discussions (FGDs) with health workers and community members were conducted to describe their perceptions on maternal referrals. Women (n=1118) were interviewed to determine awareness of obstetric danger signs and associated factors. Compliance with referral advice was analysed for 1538 women referred from PLCF. Counselling on danger signs and adherence to referral criteria was observed in 438 antenatal consultations. FGDs indicated that women had limited influence, especially on emergency referrals. The process of deciding to seek referral care considered the perception of seriousness and past experience of referral, access to transport, and the cost involved. Women had low awareness of danger signs of obstetric complications: higher years of schooling increased the likelihood of being aware of danger signs. Demographic risks accounted for 70% of referred women but less than half complied with the advice. Compliance was higher for historical obstetric risks, prenatal, natal, and postnatal complications groups. Few women were counselled on pregnancy danger signs and a significant number with ≥5 pregnancies and primigravidae <20 years were not informed of the risk factors. This thesis demonstrated a need for reviewing referral guidelines and an increase in supportive supervision for health workers counselling on obstetric danger signs to enhance acceptance of referrals advices. Women’s education should be given priority for increasing participation in decisions and becoming more aware of danger signs. Costs involved in maternal referrals can be relieved by improving family income, infrastructure, and alleviating the cost of referral through mobilising community transport and financial schemes

Safe injections and waste management at a Sub-Saharan regional hospital: a quantitative descriptive study

Objective:  To assess the knowledge and practice of safe injections and health care waste management among healthcare workers at a regional hospital in Northern Tanzania.  Design: A cross sectional descriptive study with additional observations was conducted to assess the knowledge and practice of safe injections and waste management among responsible health workers. Setting: A regional hospital in Northern Tanzania. Methods: A quantitative descriptive study was conducted through a self-administered questionnaire with additional observations of the incinerator, injections, waste practices, and the availability of medical supplies. Data was analysed in SPSS descriptive statistics and chi-square tests were performed. Results: 223 of 305 (73%) healthcare workers from different cadres were included in the study. The majority of healthcare workers had adequate knowledge and practice of safe injections, but inadequate knowledge about waste management. The majority of the staff reported knowledge of HIV as a risk factor, however, had less knowledge about other blood borne infections. Guidelines and posters on post exposure prophylaxes and waste management were present at the hospital, however, the incinerator had no fence or temperature gauge. Conclusion: Healthcare workers reported good knowledge and practice of injections, and high knowledge of HIV transmission routes. However, it is concluded that the hospital is in need of a well functioning incinerator and healthcare workers require sufficient medical supplies. There was a need for continual training about health care waste management and avoidance of blood borne pathogens that may transmit through unsafe injections or poor health care waste management

Low Use of Long-Acting Reversible Contraceptives in Tanzania: Evidence from the Tanzania Demographic and Health Survey

We aimed to determine the prevalence and factors associated with the use of long-acting reversible contraceptives (LARCs) among women of reproductive age in Tanzania. We analyzed the Tanzania Demographic and Health Survey (DHS) data from 2015 to 2016. The study included 8189 women aged 15–49 years. The relationship between various factors and LARC use was determined through various analyses. Among women with a partner/husband, 7.27% used LARCs, 21.07% were grand multiparous, and 20.56% did not desire more children. Women aged 36–49 years (adjusted odds ratio (AOR)-2.10, 95% confidence interval (CI): 1.11–3.96), who completed secondary education (AOR-1.64, 95% CI: 1.05–2.55), who did not desire more children (AOR-2.28, 95% CI: 1.53–3.41), with a partner with primary level education (AOR-2.02, 95% CI: 1.34–3.02), or living in richer households (AOR-1.60, 95% CI: 1.12–2.27) were more likely to use LARCs. Further, women with a partner who wanted more children were less likely to use LARCs (AOR-0.69, 95% CI: 0.54–0.90). Tanzania has a low LARC usage rate. Women’s age, wife and partner’s education status, couple’s desire for more children, and household wealth index influenced the use of LARCs, highlighting the need to reach more couples of lower socioeconomic status to improve LARC utilization

Women’s experience of preterm birth in an East African context: A qualitative study

Background: Approximately 15 million children are born each year prematurely, representing more than 10 percent of all childbirths worldwide. Prematurity is an acute event and the leading cause of death among newborns and children under five. Sixty percent of these premature deaths occur in Sub-Saharan Africa and Southeast Asia. Objective: The current study aimed to explore and understand women’s experiences and perceptions regarding giving birth prematurely at the National Hospital of Muhimbili in Dar es Salaam, Tanzania. Method: A qualitative method, using Interpretive Phenomenological Analysis approach was chosen to understand and describe the women’s experiences. A semi-structured guide was used during the interviews. All interviews were audio-recorded and transcribed verbatim. Findings: Eight in-depth interviews were conducted. The analysis revealed three superordinate themes: (a) Emotional turmoil: unmet expectations shattering maternal identity, emotional distress, and loss of hope; (b) Adapting to preterm birth and challenges: the unexpected situation, lack of proper care, strenuous breastfeeding routines, and socioeconomic challenges; (c) Significance of proper care and emotional support: good maternal care, mother-to-mother and family support. Conclusion: This study provided a deeper understanding of women’s experiences and perceptions of premature childbirth. The current study indicated the importance of caregivers’ awareness of the women’s emotional distress, their need to adapt to a sudden unexpected situation, and the necessity of emotional support