Improving access to emergency obstetric care in underserved rural Tanzania: a prospective cohort study
Abstract Background One of the key strategies to reducing maternal mortality is provision of emergency obstetric care services. This paper describes the results of improving availability of, and access to emergency obstetric care services in underserved rural Tanzania using associate clinicians. Met...
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| Format: | Article |
| Language: | English |
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BMC
2022-08-01
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| Series: | BMC Pregnancy and Childbirth |
| Subjects: | |
| Online Access: | https://doi.org/10.1186/s12884-022-04951-1 |
| _version_ | 1798038847877021696 |
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| author | Angelo S. Nyamtema Heather Scott John C. LeBlanc Elias Kweyamba Janet Bulemela Allan Shayo Omary Kilume Zabron Abel Godfrey Mtey |
| author_facet | Angelo S. Nyamtema Heather Scott John C. LeBlanc Elias Kweyamba Janet Bulemela Allan Shayo Omary Kilume Zabron Abel Godfrey Mtey |
| author_sort | Angelo S. Nyamtema |
| collection | DOAJ |
| description | Abstract Background One of the key strategies to reducing maternal mortality is provision of emergency obstetric care services. This paper describes the results of improving availability of, and access to emergency obstetric care services in underserved rural Tanzania using associate clinicians. Methods A prospective cohort study of emergency obstetric care was implemented in seven health centres in Morogoro region, Tanzania from July 2016 to June 2019. In early 2016, forty-two associate clinicians from five health centres were trained in teams for three months in emergency obstetric care, newborn care and anaesthesia. Two health centres were unexposed to the intervention and served as controls. Following training, virtual teleconsultation, quarterly on-site supportive supervision and continuous mentorship were implemented to reinforce skills and knowledge. Results The met need for emergency obstetric care increased significantly from 45% (459/1025) at baseline (July 2014 – June 2016) to 119% (2010/1691) during the intervention period (Jul 2016 – June 2019). The met need for emergency obstetric care in the control group also increased from 53% (95% CI 49–58%) to 77% (95% CI 74–80%). Forty maternal deaths occurred during the baseline and intervention periods in the control and intervention health centres. The direct obstetric case fatality rate decreased slightly from 1.5% (95% CI 0.6–3.1%) to 1.1% (95% CI 0.7–1.6%) in the intervention group and from 3.3% (95% CI 1.2–7.0%) to 0.8% (95% CI 0.2–1.7%) in the control group. Conclusions When emergency obstetric care services are made available the proportion of obstetric complications treated in the facilities increases. However, the effort to scale up emergency obstetric care services in underserved rural areas should be accompanied by strategies to reinforce skills and the referral system. |
| first_indexed | 2024-04-11T21:45:57Z |
| format | Article |
| id | doaj.art-76c7d515b7bd4dd9baa2a0d02dd2447a |
| institution | Directory Open Access Journal |
| issn | 1471-2393 |
| language | English |
| last_indexed | 2024-04-11T21:45:57Z |
| publishDate | 2022-08-01 |
| publisher | BMC |
| record_format | Article |
| series | BMC Pregnancy and Childbirth |
| spelling | doaj.art-76c7d515b7bd4dd9baa2a0d02dd2447a2022-12-22T04:01:25ZengBMCBMC Pregnancy and Childbirth1471-23932022-08-012211910.1186/s12884-022-04951-1Improving access to emergency obstetric care in underserved rural Tanzania: a prospective cohort studyAngelo S. Nyamtema0Heather Scott1John C. LeBlanc2Elias Kweyamba3Janet Bulemela4Allan Shayo5Omary Kilume6Zabron Abel7Godfrey Mtey8Tanzanian Training Centre for International HealthDepartment of Obstetrics and Gynaecology, Dalhousie UniversityPediatrics, Community Health and Epidemiology and Psychiatry, Dalhousie UniversityTanzanian Training Centre for International HealthTanzanian Training Centre for International HealthTanzanian Training Centre for International HealthTanzanian Training Centre for International HealthTanzanian Training Centre for International HealthTanzanian Training Centre for International HealthAbstract Background One of the key strategies to reducing maternal mortality is provision of emergency obstetric care services. This paper describes the results of improving availability of, and access to emergency obstetric care services in underserved rural Tanzania using associate clinicians. Methods A prospective cohort study of emergency obstetric care was implemented in seven health centres in Morogoro region, Tanzania from July 2016 to June 2019. In early 2016, forty-two associate clinicians from five health centres were trained in teams for three months in emergency obstetric care, newborn care and anaesthesia. Two health centres were unexposed to the intervention and served as controls. Following training, virtual teleconsultation, quarterly on-site supportive supervision and continuous mentorship were implemented to reinforce skills and knowledge. Results The met need for emergency obstetric care increased significantly from 45% (459/1025) at baseline (July 2014 – June 2016) to 119% (2010/1691) during the intervention period (Jul 2016 – June 2019). The met need for emergency obstetric care in the control group also increased from 53% (95% CI 49–58%) to 77% (95% CI 74–80%). Forty maternal deaths occurred during the baseline and intervention periods in the control and intervention health centres. The direct obstetric case fatality rate decreased slightly from 1.5% (95% CI 0.6–3.1%) to 1.1% (95% CI 0.7–1.6%) in the intervention group and from 3.3% (95% CI 1.2–7.0%) to 0.8% (95% CI 0.2–1.7%) in the control group. Conclusions When emergency obstetric care services are made available the proportion of obstetric complications treated in the facilities increases. However, the effort to scale up emergency obstetric care services in underserved rural areas should be accompanied by strategies to reinforce skills and the referral system.https://doi.org/10.1186/s12884-022-04951-1Births in emergency obstetric care facilityMet need for emergency obstetric careCase fatality rateTanzania |
| spellingShingle | Angelo S. Nyamtema Heather Scott John C. LeBlanc Elias Kweyamba Janet Bulemela Allan Shayo Omary Kilume Zabron Abel Godfrey Mtey Improving access to emergency obstetric care in underserved rural Tanzania: a prospective cohort study BMC Pregnancy and Childbirth Births in emergency obstetric care facility Met need for emergency obstetric care Case fatality rate Tanzania |
| title | Improving access to emergency obstetric care in underserved rural Tanzania: a prospective cohort study |
| title_full | Improving access to emergency obstetric care in underserved rural Tanzania: a prospective cohort study |
| title_fullStr | Improving access to emergency obstetric care in underserved rural Tanzania: a prospective cohort study |
| title_full_unstemmed | Improving access to emergency obstetric care in underserved rural Tanzania: a prospective cohort study |
| title_short | Improving access to emergency obstetric care in underserved rural Tanzania: a prospective cohort study |
| title_sort | improving access to emergency obstetric care in underserved rural tanzania a prospective cohort study |
| topic | Births in emergency obstetric care facility Met need for emergency obstetric care Case fatality rate Tanzania |
| url | https://doi.org/10.1186/s12884-022-04951-1 |
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