Assessment of the risk approach to maternity care in a district hospital in rural Tanzania

Groot, A.N.J.A. de; Slort, Willemjan; Roosmalen, Jos van

doi:10.1016/0020-7292(93)90769-s

Cited by 17 publications

(18 citation statements)

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“…The discordance between recommended and actual places of delivery suggests that the success of the risk approach to safe motherhood will be limited even if all 'risk' women are correctly identified during antenatal follow-up (17,22). Whereas long distances and transportation problems clearly influenced the place of delivery in this and previous studies (7,14), psycho-social factors probably played a rô le as well. This is suggested by such comments from 'at-risk' women as 'I just wanted to deliver at home'.…”

Section: Discussionmentioning

confidence: 62%

The relationship between antenatal risk characteristics, place of delivery and adverse delivery outcome in rural Malawi

Kulmala

Vaahtera²,

Rannikko³

et al. 2000

Acta Obstet Gynecol Scand

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Section: Discussionmentioning

confidence: 62%

The relationship between antenatal risk characteristics, place of delivery and adverse delivery outcome in rural Malawi

Kulmala

Vaahtera²,

Rannikko³

et al. 2000

Acta Obstet Gynecol Scand

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“…Even though the results reflect the respondents' place of living, and not that of the sisters who actually died, they may indicate the importance of distance. The observation that obstetric coverage declines with increasing distance, and that a greater distance and a lack of transport may contribute to an increase of maternal complications and deaths, has been observed in many studies from similar settings in sub‐Saharan Africa 23–26 .…”

Section: Discussionmentioning

confidence: 89%

Estimates of maternal mortality by the sisterhood method in rural northern Tanzania: a household sample and an antenatal clinic sample

Olsen

Hinderaker

Kazaura

et al. 2000

BJOG

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ObjectiveSetting Rural communities and antenatal clinics, Mbulu and Hanang districts, Arusha region, Tanzania.Population From a household survey 2043 men and women aged 15-60, and from an antenatal clinic survey 4172 women aged 15-59.Method The indirect sisterhood method.Main outcome measures The risk of maternal deaths per 100,000 live births (maternal mortality ratio),Results The risk of a maternal death per 100,000 live births was 362 (95% CI 269-456) and 444 (95% CI 371-517) for the household and antenatal clinic surveys, respectively. The lifetime risk of maternal death was 1 in 38 and 1 in 31, respectively, for the two surveys. A significantly lower risk of maternal death was observed for the respondents attending antenatal clinics closer to the hospital than for those attending clinics further away: 325 (95% CI 237413) compared with 561 (95% CI 446677) per 100,000 live births. Lifetime risk of maternal death was 1 in 42 and 1 in 25, respectively.Conclusions The risk of maternal death per 100,000 live births in this area were comparatively high, but in our survey substantially lower than in previous surveys in Tanzania. Increasing distance from the antenatal clinics to the hospital was associated with higher maternal mortality. There was no significant difference between results based on household and antenatal clinic data, suggesting that accessible health facility data using the sisterhood method may provide a basis for local assessment of maternal mortality in developing countries.To estimate maternal mortality in two samples of a population in northern Tanzania.and the lifetime risk of a maternal death. This quantity is often referred to as the maternal mortality ratio. Because the number of pregnancies per woman is high in many developing countries, the lifetime risk of death in connection with a pregnancy is also an important measure. The lifetime risk is the probability of dying of maternal causes cumulated across the reproductive years (35 years). Worldwide, new approaches for estimating maternal mortality levels have been sought, owing to the lack of sufficient national statistics in many countries. In 1996 a report was published by the World Health Organisation, using new models for estimation based on the former statistid. INTRODUCTIONBased on the new figures, the annual number of maternal deaths globally is estimated to be approximately 585,000. In Eastern Africa the estimate is 97,000

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“…Similar observations were made in other parts of Africa ( Voorhoeve et al . 1984 ; de Groot et al . 1993 ; Dujardin et al .…”

Section: Discussionmentioning

confidence: 99%

Obstetric care in southern Tanzania: does it reach those in need?

Jahn

Kowalewski

Kimatta³

1998

Tropical Med Int Health

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Summaryobjective To assess whether antenatal care achieves identification and timely referral of high-risk pregnancies in southern Tanzania.methods We compared the risk profiles of pregnant women in general with those attending obstetric care and investigated the reasons for seeking care. The risk profile of inpatients was drawn up through interviews with maternity cases and analysis of their antenatal records at the regional referral hospital (n ϭ 415); population-based data on the prevalence of specific risk factors were obtained from entries in antenatal care registers (n ϭ 1630) and from literature.results A significant risk selection towards obstetric referral level care was observed only for previous caesarean section (prevalence hospital 6.7%, all pregnancies 1.5%, P Ͻ 0.005) and for nulliparity (hospital 42.8%, all pregnancies 25.0%, P Ͻ 0.005). No significant differences were observed for other risk factors such as previous perinatal death, height Ͻ 150 cm, multiple gestation and breech presentation. Prevalence of the risk factors age Ͼ 34 years and grand multiparity was significantly lower among hospital users. Coverage of obstetric care was below 50% for all risk factors except previous caesarean section (91.5%).conclusion Despite pursuing the risk approach and very good coverage, antenatal care in Tanzania has only limited effect on extending obstetric care to high-risk mothers. A critical review of the present screening and counselling practices, including a more focused and client-centred application of risk assessment, is warranted.keywords Safe motherhood, antenatal care, referral system, risk approach, Tanzania correspondence Dr Albrecht Jahn,

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Assessment of the risk approach to maternity care in a district hospital in rural Tanzania

Abstract: The risk approach, used to select women with high risk pregnancies should be used more extensively and as unexpected complications at the local center occur, basic facilities to deal with those problems should be made available at this level.

Cited by 17 publications

References 1 publication

The relationship between antenatal risk characteristics, place of delivery and adverse delivery outcome in rural Malawi

The relationship between antenatal risk characteristics, place of delivery and adverse delivery outcome in rural Malawi

Estimates of maternal mortality by the sisterhood method in rural northern Tanzania: a household sample and an antenatal clinic sample

Obstetric care in southern Tanzania: does it reach those in need?

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