The impact of introducing ambulance and delivery fees in a rural hospital in Tanzania

Vossius, Corinna; Mduma, Estomih; Moshiro, Robert; Mdoe, Paschal; Kvaløy, Jan Terje; Kidanto, Hussein; Lyanga, Sara; Ersdal, Hege

doi:10.1186/s12913-021-06107-x

Cited by 4 publications

(4 citation statements)

References 18 publications

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“…The increase in more vulnerable women being admitted over time is difficult to explain based on our data alone. However, a recent paper from the same setting describes how this poor catchment population reacts to changing conditions like introducing patient fees for ambulance service and hospital delivery [ 39 ].…”

Section: Discussionmentioning

confidence: 99%

Newborn resuscitation simulation training and changes in clinical performance and perinatal outcomes: a clinical observational study of 10,481 births

et al. 2022

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Background Annually, 1.5 million intrapartum-related deaths occur; fresh stillbirths and early newborn deaths. Most of these deaths are preventable with skilled ventilation starting within the first minute of life. Helping Babies Breathe is an educational program shown to improve simulated skills in newborn resuscitation. However, translation into clinical practice remains a challenge. The aim was to describe changes in clinical resuscitation and perinatal outcomes (i.e., fresh stillbirths and 24-h newborn deaths) after introducing a novel simulator (phase 1) and then local champions (phase 2) to facilitate ongoing Helping Babies Breathe skill and scenario simulation training. Methods This is a 3-year prospective before/after (2 phases) clinical observational study in Tanzania. Research assistants observed all deliveries from September 2015 through August 2018 and recorded labor/newborn information and perinatal outcomes. A novel simulator with automatic feedback to stimulate self-guided skill training was introduced in September 2016. Local champions were introduced in October 2017 to motivate midwives for weekly training, also team simulations. Results The study included 10,481 births. Midwives had practiced self-guided skill training during the last week prior to a real newborn resuscitation in 34% of cases during baseline, 30% in phase 1, and 71% in phase 2. Most real resuscitations were provided by midwives, increasing from 66% in the baseline, to 77% in phase 1, and further to 83% in phase 2. The median time from birth to first ventilation decreased between baseline and phase 2 from 118 (85–165) to 101 (72–150) s, and time pauses during ventilation decreased from 28 to 16%. Ventilations initiated within the first minute did not change significantly (13–16%). The proportion of high-risk deliveries increased during the study period, while perinatal mortality remained unchanged. Conclusions This study reports a gradual improvement in real newborn resuscitation skills after introducing a novel simulator and then local champions. The frequency of trainings increased first after the introduction of motivating champions. Time from birth to first ventilation decreased; still, merely 16% of newborns received ventilation within the first minute as recommended. This is a remaining challenge that may require more targeted team-scenario training and quality improvement efforts to improve.

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Section: Discussionmentioning

confidence: 99%

Newborn resuscitation simulation training and changes in clinical performance and perinatal outcomes: a clinical observational study of 10,481 births

et al. 2022

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“…Urban and smaller regional hospitals in more remote regions may have even more difficulty attaining and keeping skilled staff; moreover, the availability of working bag and mask resuscitation equipment is often poor [ 14 ]. Mothers in farming and remote rural areas may have more intensive barriers to overcome in terms of having access to timely transport to the hospital, which could impact neonatal outcomes [ 53 ]. Midwives’ stories are similar in highlighting challenges of fear and lack of confidence, overwhelming workloads and an overwhelming patient-to-staff ratio [ 6 ].…”

Section: Discussionmentioning

confidence: 99%

Silent voices of the midwives: factors that influence midwives’ achievement of successful neonatal resuscitation in sub-Saharan Africa: a narrative inquiry

Becker

Oprescu

et al. 2022

BMC Pregnancy Childbirth

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Background In Tanzania, birth asphyxia is a leading cause of neonatal death. The aim of this study was to identify factors that influence successful neonatal resuscitation to inform clinical practice and reduce the incidence of very early neonatal death (death within 24 h of delivery). Methods This was a qualitative narrative inquiry study utilizing the 32 consolidated criteria for reporting qualitative research (COREQ). Audio-recorded, semistructured, individual interviews with midwives were conducted. Thematic analysis was applied to identify themes. Results Thematic analysis of the midwives’ responses revealed three factors that influence successful resuscitation: 1. Hands-on training (“HOT”) with clinical support during live emergency neonatal resuscitation events, which decreases fear and enables the transfer of clinical skills; 2. Unequivocal commitment to the Golden Minute® and the mindset of the midwife; and. 3. Strategies that reduce barriers. Immediately after birth, live resuscitation can commence at the mother’s bedside, with actively guided clinical instruction. Confidence and mastery of resuscitation competencies are reinforced as the physiological changes in neonates are immediately visible with bag and mask ventilation. The proclivity to perform suction initially delays ventilation, and suction is rarely clinically indicated. Keeping skilled midwives in labor wards is important and impacts clinical practice. The midwives interviewed articulated a mindset of unequivocal commitment to the baby for one Golden Minute®. Heavy workload, frequent staff rotation and lack of clean working equipment were other barriers identified that are worthy of future research. Conclusions Training in resuscitation skills in a simulated environment alone is not enough to change clinical practice. Active guidance of “HOT” real-life emergency resuscitation events builds confidence, as the visible signs of successful resuscitation impact the midwife’s beliefs and behaviors. Furthermore, a focused commitment by midwives working together to reduce birth asphyxia-related deaths builds hope and collective self-efficacy.

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“…In a Tanzanian study, researchers assessed the impact of introducing ambulance fees in a rural hospital. 35 After the introduction of ambulance fees, an increase in labour complications and C/S was observed. 35 In contrast, in Uganda increased uptake of maternal care services to include caesarean section deliveries upon implementation of a free 24-hr ambulance referral system.…”

Section: Interventions Targeting Second Delaysmentioning

confidence: 99%

“…35 After the introduction of ambulance fees, an increase in labour complications and C/S was observed. 35 In contrast, in Uganda increased uptake of maternal care services to include caesarean section deliveries upon implementation of a free 24-hr ambulance referral system. 36 Time is crucial in saving mothers with emergency complications.…”

Section: Interventions Targeting Second Delaysmentioning

confidence: 99%

A Strategy for Reducing Maternal Mortality in Rural Kenya

Masaba¹,

Mmusi-Phetoe²

2023

IJWH

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Background: Migori County is categorized among regions with worst maternal survival rates in Kenya. The county's current maternal mortality ratio (MMR) is 673 deaths per 100 000 live births. A need exists for a context-specific strategy to mitigate the persistent high maternal mortalities in rural Kenya. The researchers aimed to develop a strategy for reducing the maternal mortality ratio (MMR) in Migori, Kenya. Methods: An explanatory sequential mixed methods design was utilised. The design was characterised by two separate studies, an initial quantitative followed by a qualitative study. The final phase entailed integration of data from the two separate studies. The findings, extensive literature review and three delays of maternal mortality theoretical framework informed the development of the strategy. Results:The strategy for implementation considered three strategic areas, namely, interventions targeting first delays, interventions targeting second delays, interventions targeting third delays. Conclusion:The priority interventions needed are those that enable: 1) Pregnant mothers to receive quality peripartum care in Migori hospitals, 2) Strengthened and efficient referral systems of obstetric emergencies and 3) Community knowledge empowerment on safe pregnancy and culture shift. These interventions would significantly transform the health-care system towards maternal mortality reduction. The Kenyan government and non-profit organisations should be involved in the implementation of the proposed strategy.

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The impact of introducing ambulance and delivery fees in a rural hospital in Tanzania

Cited by 4 publications

References 18 publications

Newborn resuscitation simulation training and changes in clinical performance and perinatal outcomes: a clinical observational study of 10,481 births

Newborn resuscitation simulation training and changes in clinical performance and perinatal outcomes: a clinical observational study of 10,481 births

Silent voices of the midwives: factors that influence midwives’ achievement of successful neonatal resuscitation in sub-Saharan Africa: a narrative inquiry

A Strategy for Reducing Maternal Mortality in Rural Kenya

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