Trends in maternal and neonatal mortality in South Africa: a systematic review

Background Measuring and monitoring progress towards Millennium Development Goals (MDG) 4 and 5 required valid and reliable estimates of maternal and child mortality. In South Africa, there are conflicting reports on the estimates of maternal and neonatal mortality, derived from both direct and indirect estimation techniques. This study aimed to systematically review the estimates made of maternal and neonatal mortality in the period from 1990 to 2015 in South Africa and determine trends over this period. Methods Nationally-representative studies reporting on maternal and neonatal mortality in South Africa were included for synthesis. Literature search for eligible studies was conducted in five electronic databases: Medline, Africa-Wide Information, Scopus, Web of Science and CINAHL. Searches were restricted to articles written in English and presenting data covering the period between 1990 and 2015. Reference lists of retrieved articles were screened for additional publications, and grey literature was searched for relevant documents for the review. Three independent reviewers were involved in study selection, data extractions and achieving consensus. Results In total, 969 studies were retrieved and 670 screened for eligibility yielding 25 studies reporting data on maternal mortality and 14 studies on neonatal mortality. Most of the studies had a low risk of bias. Estimates from the institutional reporting differed from the international metrics with wide uncertainty/confidence intervals. Moreover, modelled estimates were widely divergent from estimates obtained through empirical methods. In the last two decades, both maternal and neonatal mortality appear to have increased up to 2009, followed by a decrease, more pronounced in the care of maternal mortality. Conclusion Estimates from both global metrics and institutional reporting, although widely divergent, indicate South Africa has not achieved MDG 4a and 5a goals but made a significant progress in reducing maternal and neonatal mortality. To obtain more accurate estimates, there is a need for applying additional estimation techniques which utilise available multiple data sources to correct for underreporting of these outcomes, perhaps the capture-recapture method. Systematic review registration PROSPERO CRD4201604276

Trends in maternal and neonatal mortality in South Africa: a systematic review protocol

Background: Measuring and monitoring progress towards Millennium Development Goals (MDG) 4 and 5 requires valid and reliable estimates of maternal and neonatal mortality. In South Africa, there are conflicting reports on the estimates of maternal and neonatal mortality, derived from both direct and indirect estimation techniques. This study aims to systematically review the estimates made of maternal and neonatal mortality in the period from 1990 to 2015 in South Africa and determine trends over this period. Methods: For the purpose of this review, searches for eligible studies will be conducted in MEDLINE, Africa-Wide Information, African Index Medicus, African Journals Online, Scopus, Web of Science and CINAHL databases. Searches will be restricted to articles written in English and presenting data covering the period between 1990 and 2015. Reference lists of retrieved articles will also be screened for additional publications. Three independent reviewers will be involved in the study selection, data extractions and achieving consensus. Study quality and risk of bias will thereafter be assessed by two authors. The results will be presented as rates/ratio with their corresponding 95% confidence/uncertainty intervals. Discussion: Identifying trends in maternal and neonatal mortality will help to track progress in MDGs 4 and 5 and will serve in evaluating interventions focusing on reducing maternal and child mortality in the country. This study will, in particular, provide the context for understanding inconsistencies in reported estimates of maternal and neonatal mortality by considering estimation methods, data sources and definitions used. Systematic review registration: PROSPERO CRD42016042769

Introduction of a learning management system at the Kilimanjaro Christian Medical University College

Background. Medical schools in Africa face daunting challenges including faculty shortages, growing class sizes, and inadequate resources. Learningmanagement systems (LMS) may be powerful tools for organising and presenting curricular learning materials, with the potential for monitoring and evaluation functions.Objective. To introduce a LMS for the first-year medical student curriculum at the Kilimanjaro Christian Medical University College (KCMU Co), inMoshi, Tanzania, in partnership with the Duke University School of Medicine (Durham, North Carolina, USA).Methods. Observations were made on the requisite information technology (IT) infrastructure and human resource needs, and participation in trainingexercises. LMS utilisation was recorded, and two (student and faculty) surveys were done.Results. The KCMU Co IT infrastructure was upgraded, and an expert team trained for LMS implementation. An introductory LMS workshop forfaculty had 7 out of 25 invitees, but attendance improved to more than 50% in subsequent workshops. Student attendance at workshops was mandatory. Use of the LMS by students rapidly expanded, and growing faculty utilisation followed later. By the end of the second semester, online examinations were offered, resulting in greater student and faculty  satisfaction owing to rapid availability of results. A year after LMS   introduction, 90% of students were accessing the LMS at least 4 days/week. A student survey identified high levels of satisfaction with the LMS software, quality of content, and learning enhancement.Conclusion. LMS can be a useful and efficient tool for curriculum  organisation, administration of online examinations, and continuous monitoring. The lessons learned from KCMU Co may be useful for similar academic settings

Building Clinical Clerkships Capacity in a Resource-limited Setting: The Case of the Kilimanjaro Christian Medical University College in Tanzania

Background: The shortage of medical doctors in sub-Saharan Africa (SSA) has resulted in increased enrolment in medical schools, which has not been matched with increased faculty size or physical infrastructure. This process has led to overcrowding and possibly reduced quality of training. To reduce overcrowding at its teaching hospital, the Kilimanjaro Christian Medical University College introduced eight-week peripheral clerkship rotations in 2012. We explore students’ perceptions and attitudes towards peripheral hospital placements. Method: The clerkship rotations were conducted in eight hospitals operating in the northern Tanzania, after evaluating each hospitals’ capabilities and establishing the optimum number of students per hospital. Paper-based surveys were conducted after student rotations from 2014 to 2016. Results: Overall student satisfaction was moderate (strength of consensus measure (sCns), 77%). The three cohorts exhibited improving trends over three years with respect to satisfaction with clinical skills and attitude towards placements. student-preceptor interaction was rated highly (sCns 81–84%). The first cohort students expressed concerns about limited laboratory support, and poor access to Internet and learning resources. Specific interventions were undertaken to address these concerns. Conclusions: Student experiences in peripheral rotations were positive with adequate satisfaction levels. Opportunities exist for medical schools in SSA to enhance clinical training and relieve overcrowding through peripheral clerkship rotations.<p