Implications of using assistant medical officers to perform caesarean sections on maternal and neonatal outcomes in the context of task sharing practice at selected secondary and primary health facilities in Tanzania

Background: Fifty-six years ago, Tanzania introduced Assistant Medical Officers (AMOs), capable of providing health services which might be performed by Medical Doctors (MDs) at primary and secondary level of care. For the purpose of this study, the primary and secondary health facilities refer to Health centres and district hospital/ Designated District Hospitals respectively. Since the country established the task sharing policy in recent years, the success rate of caesarean sections (C-sections) performed by AMOs and the maternal and neonatal outcomes, have not been systematically evaluated in the country.Objective: To assess the contribution of AMOs in performing C-sections and maternal and neonatal outcomes in primary and secondary health facilities in Tanzania.Design: A cross sectional retrospective study Setting: Three secondary and 3 primary health facilities in Kigoma, Morogoro, Mtwara and Tanga regions, Tanzania.Subjects: Four thousand, three hundred and two (4302) clinical records of Csections conducted between 1st January 2014 and 31st December 2015. Data analysis was done using IBM SPSS software package.Results: AMOs were more likely than MDs to perform elective C-sections at selected health centers and district hospitals than emergency C-sections, OR=2.52 95% CI (1.80 - 3.54); AMOs were more likely than MDs to report big baby-small maternal pelvis indications than foetal distress, OR = 1.35 95%CI (1.01 – 1.81). In both univariable and multivariable analysis, there was no statistical difference between AMO and MDs on outcome of the baby and post-operative complications.Conclusion: In this study setting, maternal and neonatal outcomes of C-sections performed by AMOs compared well with those performed by MDs. Therefore, there is a clear policy implication to consider more efforts to improve quality and outcomes with awareness of the fact that more women can access C-section services through task sharing strategy

Capacity for providing caesarean section services in selected health centres and district hospitals in Tanzania

Objective: Tanzania has a high maternal mortality ratio of 556 per 100,000 live births. Timely caesarean sections avert mortality due to life threatening conditions like obstructed labour. This study assessed capacity of selected health facilities to provide caesarean sections in terms of infrastructure, equipment, essential supplies and skill mix. Methods: A cross-sectional mixed methods design was used to include systematic observations using highly structured checklists to determine the adequacy of infrastructure, functional status of equipment, availability of supplies and skill mix. An interview guide and a key-informant interview guide were used to collect data from assistant medical officers and key informants respectively. Descriptive data analysis was conducted using IBM SPSS software package.Results: Deficit for doctors ranged between 3 (37.5%) and 5 (62.5%) per each district hospital. Two out of 3 health centres did not have doctors. Deficit for assistant medical doctors ranged between 10 (62.5%) and 11 (68.8%) per each district hospital. In terms of absolute numbers, assistant medical doctors were more than doctors. Not all facilities had all the equipment, infrastructure or supplies. Challenges cited by most assistant medical officers were; shortage of theatre-trained nurses (91%; n=21), theatres not functioning (61%; n=14), inadequate blood supply (87%; n=20) and inadequate equipment (96%; n=22).Conclusion: Capacity of health facilities to provide caesarean sections was found to be sub-optimal due to health workforce shortages, inadequate infrastructure, equipment and supplies, thus increasing the risk of maternal deaths. These findings are useful in informing strategies to reduce maternal mortality. Funding: College of Health Sciences of the University of KwaZulu-Natal Keywords: Task sharing, skill mix, surgical equipment, assistant medical officers, infrastructure, caesarean sections, obstetric drugs and medical supplie

System and market failures: the unavailability of magnesium sulphate for the treatment of eclampsia and pre-eclampsia in Mozambique and Zimbabwe.

Low cost and effective drugs, such as magnesium sulphate, need to be included in initiatives to improve access to essential medicines in Afric

Barriers and incentives to orphan care in a time of AIDS and economic crisis: a cross-sectional survey of caregivers in rural Zimbabwe

BACKGROUND: Africa is in an orphan-care crisis. In Zimbabwe, where one-fourth of adults are HIV-positive and one-fifth of children are orphans, AIDS and economic decline are straining society's ability to care for orphans within their extended families. Lack of stable care is putting thousands of children at heightened risk of malnourishment, emotional underdevelopment, illiteracy, poverty, sexual exploitation, and HIV infection, endangering the future health of the society they are expected to sustain. METHODS: To explore barriers and possible incentives to orphan care, a quantitative cross-sectional survey in rural eastern Zimbabwe asked 371 adults caring for children, including 212 caring for double orphans, about their well-being, needs, resources, and perceptions and experiences of orphan care. RESULTS: Survey responses indicate that: 1) foster caregivers are disproportionately female, older, poor, and without a spouse; 2) 98% of non-foster caregivers are willing to foster orphans, many from outside their kinship network; 3) poverty is the primary barrier to fostering; 4) financial, physical, and emotional stress levels are high among current and potential fosterers; 5) financial need may be greatest in single-orphan AIDS-impoverished households; and 6) struggling families lack external support. CONCLUSION: Incentives for sustainable orphan care should focus on financial assistance, starting with free schooling, and development of community mechanisms to identify and support children in need, to evaluate and strengthen families' capacity to provide orphan care, and to initiate and support placement outside the family when necessary

Translating research into policy: lessons learned from eclampsia treatment and malaria control in three southern African countries

<p>Abstract</p> <p>Background</p> <p>Little is known about the process of knowledge translation in low- and middle-income countries. We studied policymaking processes in Mozambique, South Africa and Zimbabwe to understand the factors affecting the use of research evidence in national policy development, with a particular focus on the findings from randomized control trials (RCTs). We examined two cases: the use of magnesium sulphate (MgSO₄) in the treatment of eclampsia in pregnancy (a clinical case); and the use of insecticide treated bed nets and indoor residual household spraying for malaria vector control (a public health case).</p> <p>Methods</p> <p>We used a qualitative case-study methodology to explore the policy making process. We carried out key informants interviews with a range of research and policy stakeholders in each country, reviewed documents and developed timelines of key events. Using an iterative approach, we undertook a thematic analysis of the data.</p> <p>Findings</p> <p>Prior experience of particular interventions, local champions, stakeholders and international networks, and the involvement of researchers in policy development were important in knowledge translation for both case studies. Key differences across the two case studies included the nature of the evidence, with clear evidence of efficacy for MgSO₄and ongoing debate regarding the efficacy of bed nets compared with spraying; local researcher involvement in international evidence production, which was stronger for MgSO₄than for malaria vector control; and a long-standing culture of evidence-based health care within obstetrics. Other differences were the importance of bureaucratic processes for clinical regulatory approval of MgSO₄, and regional networks and political interests for malaria control. In contrast to treatment policies for eclampsia, a diverse group of stakeholders with varied interests, differing in their use and interpretation of evidence, was involved in malaria policy decisions in the three countries.</p> <p>Conclusion</p> <p>Translating research knowledge into policy is a complex and context sensitive process. Researchers aiming to enhance knowledge translation need to be aware of factors influencing the demand for different types of research; interact and work closely with key policy stakeholders, networks and local champions; and acknowledge the roles of important interest groups.</p

Policy development in malaria vector management in Mozambique, South Africa and Zimbabwe

Introduction Indoor residual spraying (IRS) and insecticide-treated nets (ITNs), two principal malaria control strategies, are similar in cost and efficacy. We aimed to describe recent policy development regarding their use in Mozambique, South Africa and Zimbabwe