Improving access, quality and safety of caesarean section services in underserved rural Tanzania: The impact of knowledge translation strategies

This research was designed to study different approaches to improve access to, and quality of caesarean section services in underserved Tanzania and translate evidence into practice. In 2016, 42 associate clinicians from five health centers were trained in teams for three months in comprehensive emergency obstetric and neonatal care and anesthesia followed by post-training supportive supervision and mentorship. From 2016-2019, 2,179 caesarean sections were performed in the intervention and 969 in the control health centers. Catchment population-based caesarean section rates increased significantly in all five intervention health centers and were more than 10% in three facilities. The risk of a woman dying from complications of caesarean section in the intervention health centers was 2.3 per 1,000 caesarean sections (95% CI 0.7 - 5.3). This educational program was adopted by the government and can be used to meet the demand for caesarean section services in other underserved areas in Africa.   Cette recherche a été conçue pour étudier différentes approches pour améliorer l'accès et la qualité des services de césarienne en Tanzanie mal desservie et traduire les preuves en pratique. En 2016, 42 cliniciens associés de cinq centres de santé ont été formés en équipes pendant trois mois aux soins obstétricaux et néonatals d'urgence complets et à l'anesthésie suivis d'une supervision et d'un mentorat post-formation. De 2016 à 2019, 2 179 césariennes ont été réalisées dans les centres de santé d'intervention et 969 dans les centres de santé témoins. Les taux de césariennes dans la population desservie ont augmenté de manière significative dans les cinq centres de santé d'intervention et étaient supérieurs à 10 % dans trois établissements. Le risque qu'une femme meure des complications d'une césarienne dans les centres de santé d'intervention était de 2,3 pour 1 000 césariennes (IC à 95 % 0,7 - 5,3). Ce programme éducatif a été adopté par le gouvernement et peut être utilisé pour répondre à la demande de services de césarienne dans d'autres régions mal desservies d'Afriqu

Caesarean section audit to improve quality of care in a rural referral hospital in Tanzania

Abstract Background Caesarean section (CS) is often a life-saving procedure, but can also lead to serious complications, even more so in low-resource settings. Therefore unnecessary CS should be avoided and optimal circumstances for vaginal delivery should be created. In this study, we aim to audit indications for Caesarean sections and improve decision-making and obstetric management. Methods Audit of all cases of CS performed from January to August 2013 was performed in a rural referral hospital in Tanzania. The study period was divided in three audit blocks; retrospective (before auditing), prospective 1 and prospective 2. A local audit panel (LP) and an external auditor (EA) judged if obstetric management was adequate and indications were appropriate or if CS could have been prevented and yet retain good pregnancy outcome. Furthermore, changes in modes of deliveries, overall pregnancy outcome and decision-to-delivery interval were monitored. Results During the study period there were 1868 deliveries. Of these, 403 (21.6%) were Caesarean sections. The proportions of unjustified CS prior to introduction of audit were as high as 34 and 75%, according to the respective judgments of LP and EA. Following introduction of audit, the proportions of unjustified CS decreased to 23% (p = 0.29) and 52% (p = 0.01) according to LP and EA respectively. However, CS rate did not change (20.2 to 21.7%), assisted vacuum delivery rate did not increase (3.9 to 1.8%) and median decision-to-delivery interval was 83 min (range 10 - 390 min). Conclusions Although this is a single center study, these findings suggest that unnecessary Caesarean sections exist at an alarming rate even in referral hospitals and suggest that a vast number can be averted by introducing a focused CS audit system. Our findings indicate that CS audit is a useful tool and, if well implemented, can enhance rational use of resources, improve decision-making and harmonise practice among care providers

Abstracts of Tanzania Health Summit 2020

This book contains the abstracts of the papers/posters presented at the Tanzania Health Summit 2020 (THS-2020) Organized by the Ministry of Health Community Development, Gender, Elderly and Children (MoHCDGEC); President Office Regional Administration and Local Government (PORALG); Ministry of Health, Social Welfare, Elderly, Gender, and Children Zanzibar; Association of Private Health Facilities in Tanzania (APHFTA); National Muslim Council of Tanzania (BAKWATA); Christian Social Services Commission (CSSC); & Tindwa Medical and Health Services (TMHS) held on 25–26 November 2020. The Tanzania Health Summit is the annual largest healthcare platform in Tanzania that attracts more than 1000 participants, national and international experts, from policymakers, health researchers, public health professionals, health insurers, medical doctors, nurses, pharmacists, private health investors, supply chain experts, and the civil society. During the three-day summit, stakeholders and decision-makers from every field in healthcare work together to find solutions to the country’s and regional health challenges and set the agenda for a healthier future. Summit Title: Tanzania Health SummitSummit Acronym: THS-2020Summit Date: 25–26 November 2020Summit Location: St. Gasper Hotel and Conference Centre in Dodoma, TanzaniaSummit Organizers: Ministry of Health Community Development, Gender, Elderly and Children (MoHCDGEC); President Office Regional Administration and Local Government (PORALG); Ministry of Health, Social Welfare, Elderly, Gender and Children Zanzibar; Association of Private Health Facilities in Tanzania (APHFTA); National Muslim Council of Tanzania (BAKWATA); Christian Social Services Commission (CSSC); & Tindwa Medical and Health Services (TMHS)