“I lost my happiness, I felt half dead and half alive” - a qualitative study of the long-term aftermath of obstetric near-miss in the urban district of Zanzibar, Tanzania

Abstract

Background This study aims to explore the stories of three women from Zanzibar, Tanzania, who survived life-threatening obstetric complications. Their narratives will increase understanding of the individual and community-level burden masked behind the statistics of maternal morbidity and mortality in Tanzania. In line with a recent systematic review of women-centred, qualitative maternal morbidity research, this study will contribute to guidance of local and global maternal health agendas. Methods This two-phased qualitative study was conducted in July-August 2017 and July-August 2018, and involved three key informants, who were recruited from a maternal near-miss cohort in May 2017 in Mnazi Mmoja Hospital, Zanzibar. The used methods were participant observation, interviews (informal, unstructured and semi-structured), participatory methods and focus group discussions. Data analysis relied primarily on grounded theory, leading to a theoretical model, which was validated repeatedly by the informants and within the study team. The findings were then positioned in the existing literature. Approval was granted by Zanzibar’s Medical Ethical Research Committee (reference number: ZAMREC/0002/JUN/17). Results The impact of severe maternal morbidity was found to be multi-dimensional and to extend beyond hospital discharge and thus institutionalized care. Four key areas impacted by maternal morbidities emerged, namely (1) social, (2) sexual and reproductive, (3) psychological, and (4) economic well-being. Conclusions This study showed how three women’s lives and livelihoods were profoundly impacted by the severe obstetric complications they had survived, even up to 16 months later. These impacts took a toll on their physical, social, economic, sexual and psychological well-being, and affected family and community members alike. These findings advocate for a holistic, dignified, patient value-based approach to the necessary improvement of maternal health care in low-income settings. Furthermore, it emphasizes the need for strategies to be directed not only towards quality of care during pregnancy and delivery, but also towards support after obstetric complications.

The multidimensional impact of maternal near-miss on the lives of women in Zanzibar, Tanzania: a prospective, 1-year follow-up study

“…We had expected a higher reported rate of impairment based on the anthropological studies done among women who had suffered from severe obstetrical complications in Zanzibar and Burkina Faso. 12 , 13 There are several potential explanations. One is the concept of adaptive preferences.…”

“… 29 Another explanation could be effective social support in Zanzibari society by extended family, community, and religion, including the lived concept of tawakkul , understanding life and its course being in God's hands, motivating a certain mode of perseverance and resilience. 12 In a previous study in Zanzibar, we described a couple, of whom the woman lost her uterus, that adopted the child of a relative. 12 This helped to cope with reproductive loss in a society in which reproduction is valued highly.…”

“…Anthropological studies suggest how this impact is larger in low-income settings. 12 , 13 Costs for treatment and loss of revenue owing to sickness exacerbate the financial burden people already carry. In addition, loss of a child and loss of the ability to have children owing to an emergency hysterectomy affect over half of women who suffer from life-threatening obstetrical complications.…”

Understanding the Meaning of Lived Experience "Maternal Near Miss": A Qualitative Study Protocol

“…Finally, the authors conclude that with the increasing prevalence of near-miss mothers worldwide 40 as well as in Iran, 41 it is imperative to understand their experience. 42,43 We will probably recognize several limitations inherent in our design. Our study will be conducted at least one year of near-miss experience, sampling of these mothers is hard, given that their number is not too high according to inclusion criteria.…”

The Role of Livelihood Assets on the Improvement of the Livelihoods of Fisher Households in Zanzibar

“…The land ownership statistics showed that 58% of fishers have access to of land using for agricultural activities and livestock rearing [30]. However, fishers in Zanzibar have good cooperation in their communities, they help each other, especially during economic crises caused by lean season for fishing [31]. They fully participate in social and communities' issues such as building of schools, mosques and participate in other social activities and development activities [32].…”