Assessing unmet obstetric need in Mtwara Region, Tanzania

Abstract

Summaryobjective To evaluate maternity care, the feasibility of collecting the relevant data from hospital records, and to assess the usefulness for district health planning in the Mtwara Region, Tanzania.method A prospective study running over 2 years using the unmet obstetric need concept in all four hospitals in the region, covering all women undergoing major obstetric interventions. Data on indications, interventions, and pregnancy outcome were collected. Rates of major obstetric interventions performed for absolute maternal indications among all expected births in the study area were calculated to assess met and unmet need.results Of 2404 interventions, 91% were caesarean sections, most commonly indicated by cephalopelvic disproportion (46%). The rate of major obstetric intervention for absolute maternal indications per 100 expected births was 1.8% overall with wide rural-urban disparities (1.4% vs. 3.3%). Based on the estimated need of at least 2% of births requiring of a major obstetric intervention, seven of 20 divisions reached or surpassed this threshold, seven had a level between 1% and 2% and six did not reach 1%. Data were collected as part of the regular activities of the health staff, but external resources were needed for data management and analysis.conclusion We found a major unmet obstetric need in rural areas with a clear trend towards fewer interventions with longer distance from a hospital. Geographical mapping of the met obstetric need provided a detailed picture of deficiencies in the provision of maternity care and could be useful for priority setting and monitoring.keywords unmet obstetric need, unmet obstetric need indicator, process indicator, maternal mortality, district planning, Tanzania

A scoping review of geographic information systems in maternal health

“…Some studies used GIS to map the availability of interventions that aimed to improve maternal outcomes. For example, identifying areas with an unmet obstetric need on the basis of standards of care delivery prespecified by WHO [22,23]. Demographic data were used to quantify the potential need for obstetric intervention among populations, which was then compared with the geographic distribution of health facilities and their capacity to deliver both non‐urgent and urgent maternal care [22,23].…”

Staff experiences of providing maternity services in rural southern Tanzania – a focus on equipment, drug and supply issues

“…The coverage of EmOC in the Southern Zone of Tanzania was 0.7 facilities/500,000 people for basic emergency care, which is well below the United Nations recommended level of 4 facilities/500,000 people [19]. Data from 2000–2002 gave a rate for major obstetric interventions, essentially caesarean section, of 1.8% of expected births, indicating deficiencies in access to life-saving comprehensive EmOC in rural areas [27]. …”

Caesarean section among referred and self-referred birthing women: a cohort study from a tertiary hospital, northeastern Tanzania

“…As is the case for several sub-Saharan countries, Tanzania has had a constant low national average Caesarean section (CS) rate (3%) since 1999 [6]. This is below the minimum recommended level, reflecting considerable unmet needs for emergency obstetric care [7-9]. Where a large proportion of births take place outside facilities, an effective referral system is necessary, but not sufficient, to achieve equitable access to emergency obstetric care.…”