Maternal Mortality in Dodoma Regional Referral Hospital, Tanzania

Nassoro, Mzee; Chetto, Paul; Chiwanga, Enid; Lilungulu, Athanase; Bintabara, Deogratius; Wambura, Jacquiline

doi:10.1155/2020/9082179

Cited by 28 publications

(24 citation statements)

References 16 publications

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“…Accurate classification of causes of maternal mortality is vital for decision making and provision of care; otherwise there could be misclassification and under-identification of maternal deaths at facilities, where a woman of reproductive age may die in a medical or surgical ward with an undiagnosed obstetric complication ( 25 ). For programmatic purposes, indirect causes of maternal mortality require greater attention, not just for purposes of reporting, but also for timely decision making and interventions to prevent these deaths ( 26 ).…”

Section: Discussionmentioning

confidence: 99%

Quality of Maternal Death Documentation in Afghanistan: A Retrospective Health Facility Record Review

Maruf

Tappis²,

Stekelenburg

et al. 2021

Front. Glob. Womens Health

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Objectives: To assess the quality of health facility documentation related to maternal deaths at health facilities in Afghanistan.Methods: Analysis of a subset of findings from the 2016 National Maternal and Newborn Health Quality of Care Assessment in Afghanistan. At each facility, maternity registers were reviewed to obtain data related to maternity caseload, and number and causes of maternal deaths in the year preceding the survey. Detailed chart reviews were conducted for up to three maternal deaths per facility. Analyses included completeness of charts, quality of documentation, and cause of death using WHO application of International Statistical Classification of Disease to deaths during pregnancy, childbirth and the puerperium.Key findings: Only 129/226 (57%) of facilities had mortality registers available for review on the day of assessment and 41/226 (18%) had charts documenting maternal deaths during the previous year. We reviewed 68 maternal death cases from the 41 facilities. Cause of death was not recorded in nearly half of maternal death cases reviewed. Information regarding mode of birth was missing in over half of the charts, and one third did not capture gestational age at time of death. Hypertensive disorders of pregnancy and obstetric hemorrhage were the most common direct causes of death, followed by maternal sepsis and unanticipated complications of clinical management including anesthesia-related complications. Documented indirect causes of maternal deaths were anemia, cardiac arrest, kidney and hepatic failure. Charts revealed at least eight maternal deaths from indirect causes that were not captured in register books, indicating omission or misclassification of registered deaths.Conclusion: Considerable gaps in quality of recordkeeping exist in Afghanistan, including underreporting, misclassification and incompleteness. This hampers efforts to improve quality of maternal and newborn health data and priority setting.

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Section: Discussionmentioning

confidence: 99%

Quality of Maternal Death Documentation in Afghanistan: A Retrospective Health Facility Record Review

Maruf

Tappis²,

Stekelenburg

et al. 2021

Front. Glob. Womens Health

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“…The sample size was calculated using the formula for quantitative studies ( n = Z 2 P (1 − P )/ d 2 ) 18 with the following assumptions: n is the required sample size, P is the proportion (33.5%) of knowledge and hygienic practices for postpartum women, 11 d is the margin of error to the desired level of precision to the true value (5%), and Z is the constant standard normal variation (1.96 for 95% confidence level). Proportionate sampling method was adapted to handpick the number of study participants from each selected facility using the following formula: n i = N i / N t * n , whereas n i is the required number of respondents per each facility, N i is the total number of deliveries per each facility per day, N t is the total number of deliveries in all selected facilities, and n is the total sample size.…”

Section: Methodsmentioning

confidence: 99%

“… 10 Another study which was conducted in Dodoma region indicated that among 35 maternal deaths, 12 were due to puerperal sepsis. 11 …”

Section: Introductionmentioning

confidence: 99%

Puerperal sepsis-related knowledge and reported self-care practices among postpartum women in Dar es salaam, Tanzania

Nchimbi

Joho

2022

Womens Health (Lond Engl)

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Background: Knowledge and reported self-care practices of postpartum women are important for early detection, prevention and treatment of puerperal sepsis. Objectives: This study analyzes the knowledge and self-care practices for prevention of puerperal sepsis and their determinants among postpartum women. Methods: A hospital-based analytical cross-sectional study which included 343 postpartum women was conducted from February to March 2021. Data were collected using interviewer-administered questionnaire. Predictors of knowledge and self-care reported practice were determined using binary logistic regression. p < 0.05 was considered significant. Results: More than half ( n = 213, 62.1%) of the postpartum women had adequate knowledge on prevention of puerperal sepsis. Only 39 (11.4%) of the women reported adequate self-care practices toward prevention of puerperal sepsis. Secondary education (adjusted odds ratio = 0.18, 95% confidence interval = 0.06–0.49, p = 0.001), tertiary education (adjusted odds ratio = 0.52, 95% confidence interval = 0.19–1.38, p = 0.021) and getting information from healthcare providers (adjusted odds ratio = 1.06, 95% confidence interval = 0.55–2.06, p = 0.049) were significant determinants of knowledge on prevention of puerperal sepsis. Also, secondary education (adjusted odds ratio = 0.11, 95% confidence interval = 0.04–0.30, p = 0.001), tertiary education (adjusted odds ratio = 0.16, 95% confidence interval = 0.06–0.39, p = 0.001), and having more than four antenatal care visits (adjusted odds ratio = 1.21, 95% confidence interval = 0.49–3.27, p = 0.041) were significant determinants of reported self-care practices for prevention of puerperal sepsis. Conclusion: A significant gap in reported self-care practices to prevent puerperal sepsis was evidence. Secondary and tertiary education were significant predictors for both knowledge and self-care reported practices. Special attention should be given to women with low education level.

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“…By 2015, the maternal mortality rate in Tanzania was estimated to be 556 maternal deaths per 100,000 live births [ 7 ]. Among the factors contributing to Tanzania’s high maternal mortality rate is a weak referral system [ 8 ]. An efficient and effective referral system is critical to respond to complications which necessitate the transfer a woman and/or new-born with intrapartum complications to the next level health facility.…”

Section: Introductionmentioning

confidence: 99%

Understanding barriers to implementing referral procedures in the rural and semi-urban district hospitals in Tanzania: Experiences of healthcare providers working in maternity units

et al. 2021

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Introduction Maternal and perinatal deaths occurring in low and middle income countries could be prevented with timely access to maternal and new-born care. In order to increase access to maternal and child health services, a well-functioning referral system that allows for continuity of care across different tiers of healthcare is required. A reliable healthcare system, with adequate numbers of skilled staff, resources and mechanisms, is critical to ensuring that access to care is available when the need arises. Material and methods This descriptive, qualitative study design was used to explore barriers to implementing a reliable referral system. Twelve individual qualitative interviews were conducted with health care providers working in rural and semi-urban district hospitals in the Northern, Western, Eastern and Southern zones of Tanzania. Thematic analysis guided analysis of data. Results Three (3) main and interconnected themes were abstracted from the data relating to participants’ experiences of referring women with obstetric complications to adequate obstetric care. These were: 1. Adhering to a rigid referral protocol; 2. Completing the referral of women to an adequate health facility and 3. Communicating the condition of the woman with obstetric complications between the referring and receiving facilities. Conclusion Because of referral regulations, assistant medical officers were unable to make referral decisions even when they felt that a referral was needed. The lack of availability of hospital transport as well as the lack of a reliable feedback mechanism, prohibited effective referrals of patients. The Ministry of Health should revise the referral protocol to allow all clinicians to provide referrals, including assistant medical officers- who make up the majority of clinical staff in rural health care facilities. A mechanism to ensure effective communication between the referral facility and the tertiary care hospital should be instituted for quality and continuity of care. Furthermore, health care facilities should put aside budget for fuelling the ambulance for effective referrals.

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Maternal Mortality in Dodoma Regional Referral Hospital, Tanzania

Cited by 28 publications

References 16 publications

Quality of Maternal Death Documentation in Afghanistan: A Retrospective Health Facility Record Review

Quality of Maternal Death Documentation in Afghanistan: A Retrospective Health Facility Record Review

Puerperal sepsis-related knowledge and reported self-care practices among postpartum women in Dar es salaam, Tanzania

Understanding barriers to implementing referral procedures in the rural and semi-urban district hospitals in Tanzania: Experiences of healthcare providers working in maternity units

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