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This paper evaluates the safety and acceptability of long-term community-based use of misoprostol for management of postpartum hemorrhage (PPH) in home-births, by comparing deliveries with and without misoprostol use in communities of... more
This paper evaluates the safety and acceptability of long-term community-based use of misoprostol for management of postpartum hemorrhage (PPH) in home-births, by comparing deliveries with and without misoprostol use in communities of Kigoma, Tanzania. We administered a standardized survey instrument to women who delivered between August 2004 and May 2007. 940 women completed questionnaires, corresponding to 950 deliveries. Findings showed that the majority of TBAs administered misoprostol at the correct time (76%). Receipt of three or five tablets was most commonly reported (47% and 43% respectively). Misoprostol users were significantly more likely to experience shivering, high temperature, nausea, and vomiting after delivery; adjustment for gynecological history and delivery characteristics revealed no significant differences in experience of symptoms. Misoprostol was highly acceptable to all women surveyed. Misoprostol at the community level is a safe intervention.
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To measure the extent, determinants and results of bypassing local primary care clinics for childbirth among women in rural parts of the United Republic of Tanzania. Women were selected in 2012 to complete a structured interview from a... more
To measure the extent, determinants and results of bypassing local primary care clinics for childbirth among women in rural parts of the United Republic of Tanzania. Women were selected in 2012 to complete a structured interview from a full census of all 30076 households in clinic catchment areas in Pwani region. Eligibility was limited to those who had delivered between 6 weeks and 1 year before the interview, were at least 15 years old and lived within the catchment areas. Demographic and delivery care information and opinions on the quality of obstetric care were collected through interviews. Clinic characteristics were collected from staff via questionnaires. Determinants of bypassing (i.e. delivery of the youngest child at a health centre or hospital without provider referral) were analysed using multivariate logistic regression. Bypasser and non-bypasser birth experiences were compared in bivariate analyses. Of 3019 eligible women interviewed (93% response rate), 71.0% (2144) delivered in a health facility; 41.8% (794) were bypassers. Bypassing likelihood increased with primiparity (odds ratio, OR: 2.5; 95% confidence interval, CI: 1.9-3.3) and perceived poor quality at clinics (OR: 1.3; 95% CI: 1.0-1.7) and decreased if clinics recently underwent renovations (OR: 0.39; 95% CI: 0.18-0.84) and/or performed ≥ 4 obstetric signal functions (OR: 0.19; 95% CI: 0.08-0.41). Bypassers reported better quality of care on six of seven quality of care measures. Many pregnant women, especially first-time mothers, choose to bypass local primary care clinics for childbirth. Perceived poor quality of care at clinics was an important reason for bypassing. Primary care is failing to meet the obstetric needs of many women in this rural, low-income setting.
Research Interests: Primary Health Care, Quality of Mental Health Care, Adolescent, Tanzania, Hospitals, and 15 moreMultivariate Analysis, Pregnancy, Humans, Female, Young Adult, Patient Satisfaction, Adult, Pregnant Women, Parturition, Parity, Rural Health Services, Cross Sectional Studies, Censuses, Logistic Models, and Socioeconomic Factors
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Page 1. From Department of Public Health Sciences Division of International Health (IHCAR) Karolinska Institutet, Stockholm, Sweden ENHANCING SURVIVAL OF MOTHERS AND THEIR NEWBORNS IN TANZANIA Godfrey Mbaruku Stockholm 2005 Page 2. ...
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An intervention programme aiming at a reduction of maternal deaths in the Regional Hospital, Kigoma, Tanzania, is analyzed. A retrospective study was carried out from 1984-86 to constitute a background for an intervention programme in... more
An intervention programme aiming at a reduction of maternal deaths in the Regional Hospital, Kigoma, Tanzania, is analyzed. A retrospective study was carried out from 1984-86 to constitute a background for an intervention programme in 1987-91. The retrospective study revealed gross under-registration of data and clarified a number of potentially useful issues regarding avoidable maternal mortality. An intervention programme comprising 22 items was launched and the maternal mortality ratio was carefully followed in 1987-91. The intervention programme paid attention to professional responsibilities with regular audit-oriented meeting, utilization of local material resources, schedules for regular maintenance of equipment, maintenance of working skills by regular on-the-job training of staff, norms for patient management, provision of blood, norms for referral of severely ill patients, use of antibiotics, regular staff evaluation, public complaints about patient management, travel distance of all essential staff to the hospital, supply of essential drugs, the need of a small infusion production unit, the creation of culture facilities for improved quality of microbiology findings, and to efforts to stimulate local fund-raising. The results indicate that the maternal mortality ratio fell from 933 to 186 per 100,000 live births over the period 1984-91. Thus it is underscored that the problem of maternal mortality can be successfully approached by a low-cost intervention programme aiming at identifying issues of avoidability and focusing upon locally available problem solutions.
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Research Interests:
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Research Interests: Survey Methodology, Distributed System, Democratic Republic of Congo, Health Services, Hiv Infection, and 10 moreSample Size, Condom use, HIV testing, Public health systems and services research, Conflict and Health, Mobile Network, Population Study, Conflict and Mental Health, Age Groups, and Protective Factor
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Research Interests: Nursing, Developing Countries, Adolescent, Tanzania, Pregnancy, and 18 moreHumans, Female, Young Adult, Patient Compliance, Risk factors, Middle Aged, Longitudinal Studies, Adult, Maternal Age, Public health systems and services research, Retrospective Studies, World Health Organization, Educational Status, Risk Factors, Parity, Birth Intervals, Logistic Models, and Marital Status(Humans, Female, Young Adult, Patient Compliance, Risk factors, Middle Aged, Longitudinal Studies, Adult, Maternal Age, Public health systems and services research, Retrospective Studies, World Health Organization, Educational Status, Risk Factors, Parity, Birth Intervals, Logistic Models, and Marital Status)
(Humans, Female, Young Adult, Patient Compliance, Risk factors, Middle Aged, Longitudinal Studies, Adult, Maternal Age, Public health systems and services research, Retrospective Studies, World Health Organization, Educational Status, Risk Factors, Parity, Birth Intervals, Logistic Models, and Marital Status)
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While antenatal care does not directly contribute to reducing maternal mortality, it may play an indirect role by encouraging women to deliver with a skilled birth attendant or in a health facility. We investigated whether the frequency... more
While antenatal care does not directly contribute to reducing maternal mortality, it may play an indirect role by encouraging women to deliver with a skilled birth attendant or in a health facility. We investigated whether the frequency of visits and select characteristics of antenatal care were associated with facility delivery. We selected a population-representative sample of households in a rural district of western Tanzania. Women who had given birth within five years were asked about their most recent delivery and antenatal care. Of 1,204 women interviewed, 1,195 (99.3%) made at least one antenatal care visit, while only 438 (36.4%) delivered in a health facility. In adjusted analysis, women were significantly more likely to deliver in a health facility if they attended antenatal care at a government health center (OR 3.17, 95% CI: 1.60-6.30) or a mission facility (OR 2.87, 95% CI: 1.36-6.07), rather than a government dispensary. Women were significantly less likely to deliver in a health facility if their nearest health facility was outside their village (OR 0.38, 95% CI: 0.22-0.66). Though facility utilization for antenatal care is frequent, most women who accessed antenatal care did not deliver in a health facility. Women who obtained antenatal care at higher level government facilities or mission facilities, which offered better quality of care, were more likely to deliver in any facility. Improving the quality of antenatal care may improve the health of mothers through encouraging women to return to facilities for delivery.
Research Interests: Program Evaluation, Research Methodology, Primary Health Care, Behavior, Reproduction, and 20 moreDeveloping Countries, Health, Adolescent, Tanzania, Maternal Health, Quality of Care, Maternal Mortality, Interviews, Pregnancy, Humans, Female, Population based study, Cluster Analysis, Young Adult, Data Collection, Maternal child health, Questionnaires, Adult, Antenatal Care, and Logistic Models(Developing Countries, Health, Adolescent, Tanzania, Maternal Health, Quality of Care, Maternal Mortality, Interviews, Pregnancy, Humans, Female, Population based study, Cluster Analysis, Young Adult, Data Collection, Maternal child health, Questionnaires, Adult, Antenatal Care, and Logistic Models)
(Developing Countries, Health, Adolescent, Tanzania, Maternal Health, Quality of Care, Maternal Mortality, Interviews, Pregnancy, Humans, Female, Population based study, Cluster Analysis, Young Adult, Data Collection, Maternal child health, Questionnaires, Adult, Antenatal Care, and Logistic Models)
Research Interests: Research Methodology, Poverty, Primary Health Care, Reproduction, Tropical Medicine, and 24 moreTreatment, Developing Countries, Transportation, Economic Development, Health, Home Economics, Public Health, Tanzania, Maternal Health, Medicine, Tropical medicine (Health Sciences), Pregnancy, Population, Humans, United States, Female, Financing, Rural Women, Public health systems and services research, Indexation, Out - Of- Pocket Payments, Prenatal Care, Transport Costs, and Confidence Interval(Treatment, Developing Countries, Transportation, Economic Development, Health, Home Economics, Public Health, Tanzania, Maternal Health, Medicine, Tropical medicine (Health Sciences), Pregnancy, Population, Humans, United States, Female, Financing, Rural Women, Public health systems and services research, Indexation, Out - Of- Pocket Payments, Prenatal Care, Transport Costs, and Confidence Interval)
(Treatment, Developing Countries, Transportation, Economic Development, Health, Home Economics, Public Health, Tanzania, Maternal Health, Medicine, Tropical medicine (Health Sciences), Pregnancy, Population, Humans, United States, Female, Financing, Rural Women, Public health systems and services research, Indexation, Out - Of- Pocket Payments, Prenatal Care, Transport Costs, and Confidence Interval)
Research Interests: Obstetrics, Perception, Research Methodology, Primary Health Care, Behavior, and 19 moreReproduction, Developing Countries, Midwifery, Health, Public Health, Tanzania, Maternal Health, Birth, Pregnancy, Population, Humans, Female, Gynecology and Obstetrics, Patient Satisfaction, Rural Areas, Questionnaires, Gynecology, Adult, and Rural Health Services
Background Although some studies in Tanzania have addressed the question of sexuality and STIs among adolescents, mostly those aged 15 - 19 years, evidence on how multiple sexual partners influence condom use among 10 - 19 year-olds is... more
Background Although some studies in Tanzania have addressed the question of sexuality and STIs among adolescents, mostly those aged 15 - 19 years, evidence on how multiple sexual partners influence condom use among 10 - 19 year-olds is limited. This study attempts to bridge this gap by testing a hypothesis that sexual relationships with multiple partners in the age group 10 - 19 years spurs condom use during sex in four districts in Tanzania. Methods Secondary analysis was performed using data from the Adolescents Module of the cross-sectional household survey on Maternal, Newborn and Child Health (MNCH) that was done in Kigoma, Kilombero, Rufiji and Ulanga districts, Tanzania in 2008. A total of 612 adolescents resulting from a random sample of 1200 households participated in this study. Pearson Chi-Square was used as a test of association between multiple sexual partners and condom use. Multivariate logistic regression model was fitted to the data to assess the effect of multiple sexual partners on condom use, having adjusted for potential confounding variables. STATA (10) statistical software was used to carry out this process at 5% two-sided significance level. Results Of the 612 adolescents interviewed, 23.4% reported being sexually active and 42.0% of these reported having had multiple (> 1) sexual partners in the last 12 months. The overall prevalence of condom use among them was 39.2%. The proportion using a condom at the last sexual intercourse was higher among those who knew that they can get a condom if they want than those who did not. No evidence of association was found between multiple sexual partners and condom use (OR = 0.77, 95% CI = 0.35 - 1.67, P = 0.504). With younger adolescents (10 - 14 years) being a reference, condom use was associated with age group (15 - 19: OR = 3.69, 95% CI = 1.21 - 11.25, P = 0.022) and district of residence (Kigoma: OR = 7.45, 95% CI = 1.79 - 31.06, P = 0.006; Kilombero: OR = 8.89, 95% CI = 2.91 - 27.21, P Conclusion No evidence of association was found between multiple sexual partners and condom use among adolescents in the study area. The large proportion of adolescents who engage in sexual activity without using condoms, even those with multiple partners, perpetuates the risk of transmission of HIV infections in the community. Strategies such as sex education and easing access to and making a friendly environment for condom availability are important to address the risky sexual behaviour among adolescents.
Research Interests: Child health, Sexual Behaviour, Adolescent, Tanzania, Prevention, and 23 moreHumans, Child, Sex Education, Female, Male, Sexual Behavior, Young Adult, Hiv Infection, Statistical software, Condom use, Random sampling, Cross Section, Public health systems and services research, Household Survey, Sexual Activity, Logistic Regression Model, Condoms, Sexual Partners, Cross Sectional Studies, Sexually Transmitted Diseases, Safe Sex, Logistic Models, and Age Groups(Humans, Child, Sex Education, Female, Male, Sexual Behavior, Young Adult, Hiv Infection, Statistical software, Condom use, Random sampling, Cross Section, Public health systems and services research, Household Survey, Sexual Activity, Logistic Regression Model, Condoms, Sexual Partners, Cross Sectional Studies, Sexually Transmitted Diseases, Safe Sex, Logistic Models, and Age Groups)
(Humans, Child, Sex Education, Female, Male, Sexual Behavior, Young Adult, Hiv Infection, Statistical software, Condom use, Random sampling, Cross Section, Public health systems and services research, Household Survey, Sexual Activity, Logistic Regression Model, Condoms, Sexual Partners, Cross Sectional Studies, Sexually Transmitted Diseases, Safe Sex, Logistic Models, and Age Groups)