Perceived Health System Causes of Obstetric Fistula from Accounts of Affected Women in Rural Tanzania: A qualitative study

Obstetric fistula is still a major problem in low income countries. While its main cause is untreated obstructed labour, misconceptions about it still persist. This study aimed at exploring and describing perceived health system causes of obstetric fistula from women affected by it in rural Tanzania. This exploratory qualitative study included twenty-eight women affected by obstetric fistula. Semi structured interviews and focus group discussions were held and thematic analysis used to analyse perceived health system causes of obstetric fistula from women’s account. Perceived health system causes of obstetric fistula fundamentally reflected the poor quality of obstetric care women received at health care facilities relating to staff unaccountability, late referral, and torture by nurses. The women's perception emphasizes the importance of improving the quality of obstetric care provided by health care providers in health care facilities. Keywords: Obstetric fistula, perceived causes, health system, birth experiences, Tanzani

Why Give Birth in Health Facility? Users' and Providers' Accounts of Poor Quality of Birth Care in Tanzania.

In Tanzania, half of all pregnant women access a health facility for delivery. The proportion receiving skilled care at birth is even lower. In order to reduce maternal mortality and morbidity, the government has set out to increase health facility deliveries by skilled care. The aim of this study was to describe the weaknesses in the provision of acceptable and adequate quality care through the accounts of women who have suffered obstetric fistula, nurse-midwives at both BEmOC and CEmOC health facilities and local community members. Semi-structured interviews involving 16 women affected by obstetric fistula and five nurse-midwives at maternity wards at both BEmOC and CEmOC health facilities, and Focus Group Discussions with husbands and community members were conducted between October 2008 and February 2010 at Comprehensive Community Based Rehabilitation in Tanzania and Temeke hospitals in Dar es Salaam, and Mpwapwa district in Dodoma region. Health care users and health providers experienced poor quality caring and working environments in the health facilities. Women in labour lacked support, experienced neglect, as well as physical and verbal abuse. Nurse-midwives lacked supportive supervision, supplies and also seemed to lack motivation. There was a consensus among women who have suffered serious birth injuries and nurse midwives staffing both BEmOC and CEmOC maternity wards that the quality of care offered to women in birth was inadequate. While the birth accounts of women pointed to failure of care, the nurses described a situation of disempowerment. The bad birth care experiences of women undermine the reputation of the health care system, lower community expectations of facility birth, and sustain high rates of home deliveries. The only way to increase the rate of skilled attendance at birth in the current Tanzanian context is to make facility birth a safer alternative than home birth. The findings from this study indicate that there is a long way to go

Preparing Institutions to Implement Harmonized Medicine and Nursing Curricula Through the Use of Cross-Institutional Faculty Developers

Doreen Anna Mloka,1 Francis Sakita,2 Irene Kida Minja,3 Haruna Dika,4 Edith AM Tarimo,5 Nathanael Sirili,6 Lillian Teddy Mselle,7 Rodrick Richard Kisenge,8 Philip Sasi,9 Livuka Nsemwa,10 Delfina R Msanga,11 Einoti Yohana Matayan,12 Nicholaus Bartholomeo Ngowi,13 Mainen Julius Moshi,14 John Bartlett,15 Sarah B Macfarlane,16 Ephata Kaaya,17 Patricia S O’Sullivan18 1Department of Pharmaceutical Microbiology, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania; 2Department of Emergency Medicine, Kilimanjaro Christian Medical University College, Moshi, Tanzania; 3Department of Restorative Dentistry, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania; 4Department of Anatomy, Catholic University of Health and Allied Sciences, Mwanza, Tanzania; 5Department of Nursing Management, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania; 6Department of Development Studies, Muhimbili University of Health and Allied Sciences, School of Public Health and Social Sciences, Dar es Salaam, Tanzania; 7Department of Clinical Nursing, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania; 8Department of Pediatrics and Child Health, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania; 9Department of Pharmacology, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania; 10Department of Nursing and Midwifery, Catholic University of Health and Allied Sciences, Mwanza, Tanzania; 11Department of Pediatrics and Child Health, Catholic University of Health and Allied Sciences, Mwanza, Tanzania; 12Department of Ophthalmology, Kilimanjaro Christian Medical University College, Moshi, Tanzania; 13Department of Surgery, Kilimanjaro Christian Medical University College, Moshi, Tanzania; 14Department of Biological and Preclinical Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania; 15Department of Global Health and Medicine, Duke University, Durham, NC, USA; 16Department of Global Health Sciences, University of San Francisco California, San Francisco, CA, USA; 17Department of Pathology, Kilimanjaro Christian Medical University College, Moshi, Tanzania; 18Office of Research and Development in Medical Education, University of San Francisco California, San Francisco, CA, USACorrespondence: Doreen Anna Mloka, Department of Pharmaceutical Microbiology, Muhimbili University of Health and Allied Sciences, 9 United Nations Road, P.O. Box 650013, Dar es Salaam, Tanzania, Tel +255712459528, Email [email protected]: Effective implementation of new curricula requires faculty to be knowledgeable about curriculum goals and have the appropriate pedagogical skills to implement the curriculum, even more so if the new curriculum is being deployed at multiple institutions. In this paper, we describe the process of creating a common faculty development program to train cross-institutional faculty developers to support the implementation of national harmonized medicine and nursing curricula.Methods: A five-step approach was used, including a cross-institutional needs assessment survey for faculty development needs, the development of a generic faculty development program, the identification and training of cross-institutional faculty educators, and the implementation of cross-institutional faculty capacity-building workshops.Results: A list of common cross-cutting faculty development needs for teaching and learning was identified from the needs assessment survey and used to develop an accredited, cross-institutional faculty development program for competency-based learning and assessment. A total of 24 cross-institutional faculty developers were identified and trained in 8 core learning and assessment workshops. A total of 18 cross-institutional and 71 institutional workshops were conducted, of which 1292 faculty members and 412 residents were trained, and three cross-institutional educational research projects were implemented.Conclusion: The success attained in this study shows that the use of cross-institutional faculty developers is a viable model and sustainable resource that can be used to support the implementation of harmonized national curricula.Keywords: faculty development across institution

Predictors of nurses’ and midwives’ intentions to provide maternal and child healthcare services to adolescents in South Africa

BACKGROUND: Adolescent mothers are at a much higher risk for maternal mortality compared to mothers aged 20 years and above. Newborns born to adolescent mothers are also more likely to have low birth weight, with the risk of long-term effects such as early onset of adult diabetes than newborns of older mothers. Few studies have investigated the determinants of adequate quality maternal and child healthcare services to pregnant adolescents. This study was conducted to gain an understanding of nurses’ and midwives’ intentions to provide maternal and child healthcare and family planning services to adolescents in South Africa. METHODS: A total of 190 nurses and midwives completed a cross-sectional survey. The survey included components on demographics, knowledge of maternal and child healthcare (MCH) and family planning (FP) services, attitude towards family planning services, subjective norms regarding maternal and child healthcare and family planning services, self-efficacy with maternal and child healthcare and family planning services, and intentions to provide maternal and child healthcare and family planning services to adolescents. Pearson’s correlation analysis was conducted to determine the association between knowledge, attitude, subjective norms, self-efficacy, and intention variables for FP and MCH services. A 2-step linear regression analysis was then conducted for both FP and MCH services to predict the intentions to provide FP and MCH services to adolescents. RESULTS: Self-efficacy to conduct MCH services (β = 0.55, p < 0.01) and years of experience as a nurse- midwife (β = 0.14, p < 0.05) were associated with stronger intentions to provide the services. Self-efficacy to provide FP services (β = 0.30, p < 0.01) was associated with stronger intentions to provide FP services. CONCLUSIONS: Self-efficacy has a strong and positive association with the intentions to provide both MCH and FP services, while there is a moderate association with attitude and norms. There is a need to improve and strengthen nurses’ and midwives’ self-efficacy in conducting both MCH and FP services in order to improve the quality and utilization of the services by adolescents in South Africa.IS