Assessing emergency obstetric and newborn care:Can performance indicators capture health system weaknesses?

Background: Regular monitoring and assessment of performance indicators for emergency obstetric and newborn care can help to identify priorities to improve health services for women and newborns. The aim of this study was to perform a district wide assessment of emergency obstetric and newborn care performance and identify ways for improvement. Methods: Facility assessment of 13 dispensaries, four health centers and one district hospital in a rural district in Tanzania was performed in two data collection periods in 2014. Assessment included a facility walk-through to observe facility infrastructure and interviews with facility in-charges to assess available services, staff and supplies. In addition facility statistics were collected for the year 2013. Results were discussed with district representatives. Results: Approximately 65% of expected births took place in health facilities and 22% of women with complications were treated in facilities expected to provide emergency care. None of the facilities was, however, able to perform at the expected level for emergency obstetric and newborn care since not all required signal functions could be provided. Inadequate availability of essential drugs such as uterotonics, antibiotics and anticonvulsants as well as lack of ability to perform vacuum extraction and blood transfusion limited performance. Conclusions: Performance of emergency obstetric and newborn care in Magu District was not in accordance with expected guidelines and highly influenced by lack of available resources and an insufficiently functioning health care system. Improving assessment approaches, to look beyond the signal functions, can capture weaknesses in the system and will help to understand poor performance and identify locally applicable ways for improvement

Symphysis-fundal height, gestational age and its value for identification of foetuses at risk in rural Tanzania: A qualitative follow-up study

Preterm birth and abnormal foetal growth increase the risk of perinatal morbidity and mortality. Timely identification of foetuses at risk is critical to improving maternal and neonatal outcomes. The objective of this study was to increase understanding of the quality of foetal growth monitoring during antenatal care in Tanzania. Between 2015 and 2017, 13 women were followed throughout their pregnancy, childbirth and postpartum period. Participants were recruited using a staggered approach at selected health facilities. Data collection included direct observations of 25 of 48 antenatal care consultations, review of the women’s antenatal cards, 88 in-depth interviews and participant observation at the health facilities. Six women had facility births and seven had home births. There was one stillbirth, one preterm birth and two term infants died between the age of 3-6 months. Of the 9 newborns with a known birthweight, 3 were possibly growth-restricted. During 12 ANC visits (25%) Symphysis-Fundal Height (SFH) was not recorded and during 22 visits (46%) the recorded Gestational Age (GA) was incorrect. Despite regular assessment of SFH, three possible growth-restricted infants remained undetected. There is a need to improve nurse-midwives ability to determine a reliable GA and improve critical reflection on SFH measurement. (Afr J Reprod Health 2021; 25[5]: 140-149)

Symphysis-fundal height, gestational age and its value for identification of foetuses at risk in rural Tanzania: A qualitative follow-up study

Preterm birth and abnormal foetal growth increase the risk of perinatal morbidity and mortality. Timely identification of foetuses at risk is critical to improving maternal and neonatal outcomes. The objective of this study was to increase understanding of the quality of foetal growth monitoring during antenatal care in Tanzania. Between 2015 and 2017, 13 women were followed throughout their pregnancy, childbirth and postpartum period. Participants were recruited using a staggered approach at selected health facilities. Data collection included direct observations of 25 of 48 antenatal care consultations, review of the women's antenatal cards, 88 in-depth interviews and participant observation at the health facilities. Six women had facility births and seven had home births. There was one stillbirth, one preterm birth and two term infants died between the age of 3-6 months. Of the 9 newborns with a known birthweight, 3 were possibly growth-restricted. During 12 ANC visits (25%) Symphysis-Fundal Height (SFH) was not recorded and during 22 visits (46%) the recorded Gestational Age (GA) was incorrect. Despite regular assessment of SFH, three possible growth-restricted infants remained undetected. There is a need to improve nurse-midwives ability to determine a reliable GA and improve critical reflection on SFH measurement. (Afr J Reprod Health 2021; 25[5]: 140-149)