Background An increase in the uptake of skilled birth attendance is expected to reduce maternal mortality in low- and middle-income countries. In Tanzania, the proportion of deliveries assisted by a skilled birth attendant is only 64% and the maternal mortality ratio is still 398/100.000 live births. This article explores different aspects of quality of care and respectful care in relation to maternal healthcare. It then examines the influence of these aspects of care on the uptake of skilled birth attendance in Tanzania in order to offer recommendations on how to increase the skilled birth attendance rate. Methods This narrative review employed the “person-centered care framework for reproductive health equity” as outlined by Sudhinaraset (2017). Academic databases, search engines and websites were consulted, and snowball sampling was used. Full-text English articles from the last 10 years were included. Results Uptake of skilled birth attendance was influenced by different aspects of technical quality of maternal care as well as person-centred care, and these factors were interrelated. For example, disrespectful care was linked to factors which made the working circumstances of healthcare providers more difficult such as resource shortages, low levels of integrated care, inadequate referral systems, and bad management. These issues disproportionately affected rural facilities. However, disrespectful care could sometimes be attributed to personal attitudes and discrimination on the part of healthcare providers. Dissatisfied patients responded with either quiet acceptance of the circumstances, by delivering at home with a traditional birth attendant, or bypassing to other facilities. Best practices to increase respectful care show that multi-component interventions are needed on birth preparedness, attitude and infrastructure improvement, and birth companionship, with strong management and accountability at all levels. Conclusions To further increase the uptake of skilled birth attendance, respectful care needs to be addressed within strategic plans. Multi-component interventions are required, with multi-stakeholder involvement. Participation of traditional birth attendants in counselling and referral can be considered. Future advances in information and communication technology might support improved quality of care.

BackgroundAfter the introduction of the maternal near-miss (MNM) criteria by the World Health Organization (WHO), an adapted version for low-income countries was defined but has never been validated in a rural hospital in this setting. Aim of this study was to identify the occurrence of MNM by both the use of the WHO and the adapted sub-Saharan Africa (SSA) MNM tool and to compare the applicability of both versions. MethodsThis cross-sectional study was done between November 2019 and July 2020 in Ndala Hospital, Tanzania. All pregnant women and women within 42 days after giving birth or termination of pregnancy were included when fulfilling at least one criterion according to either the WHO or the SSA MNM tool. ResultsThe SSA MNM criteria identified 47 near-miss cases and all seven maternal deaths. The WHO criteria identified ten near-miss cases and five maternal deaths. There were 948 livebirths, consequently leading to maternal near-miss ratio (MNMR) of 50 (95% CI 34-60) and 11 (95% CI 4 -16) per 1,000 livebirths for the SSA criteria and respectively the WHO MNM criteria. The difference in these numbers seems to be primarily attributed to the addition of defined severe complications in the clinical criteria and the adapted threshold for blood transfusions. Eclampsia and severe malaria form roughly half of these complications.