Birth Preparedness and Complication Readiness among Women in Mpwapwa District; Tanzania

Abstract:Avoidable mortality and morbidity remains a formidable challenge in many developing countries like Tanzania. Birth preparedness and complication readiness by mothers are critical in reducing morbidities and mortalities due to these complications. The aim of this study was to assess knowledge and practices with respect to birth preparedness and complication readiness among women in Mpwapwa district in Tanzania. A total of 600 women who became pregnant and or gave birth two years preceding the survey were interviewed. Among them 587 (97.8) attended antenatal clinic (ANC) at least once during their last pregnancy. Two thirds of those who attended ANC made four or more visits. The median gestation age at booking for antenatal care was 16 weeks. However; 73.9 the women booked after 16 weeks of gestation. Two thirds of the women were 20-34years old and had at least primary education level. Three hundred and forty six (57.7) had parity between two and four. Only 14.8 of the women knew three or more obstetric danger signs. The obstetric danger signs most commonly known included vaginal bleeding during pregnancy (19); foul smelling vaginal discharge (15) and baby stops moving (14.3). The majority (86.2) of the women had decisions made on place of delivery; a person to make final decision; a person to assist during delivery; someone to take care of the family and a person to escort her to health facility. Majority (68.1) of the women planned to be delivered by skilled attendant. One third of the women planned to deliver at home in the absence of a skilled birth attendant. In the bivariate analysis; age of the woman; education; marital status; number of ANC visits and knowing ?3 obstetric danger signs were associated with birth preparedness and complication readiness. In multivariate logistic regression analysis; women with primary education and above were twice more likely to be prepared and ready for birth and complications. Women who knew ?3 obstetric danger signs were 3 times more likely to be prepared for birth and complications. In conclusion; women with higher level of education and those who knew obstetric complications were more prepared for birth and complications. Further studies are recommended to find out why women do not prepare for birth or complications especially that need blood transfusion

Emergency Peripartum Hysterectomies at Muhimbili National Hospital; Tanzania: A Review of Cases from 2003 to 2007

Abstract:A retrospective review of all cases of emergency peripartum hysterectomy performed between January 1; 2003 and December 31; 2007 at Muhimbili National Hospital was done to determine the incidence; indications and complications; background characteristics; antenatal care attendance; referral status; and maternal and foetal outcomes. There were 55;152 deliveries during the study period and 165 cases of emergency peripartum hysterectomy; giving the incidence of emergency peripartum hysterectomy of 3 per 1000 deliveries. The main indication was uterine rupture (79) followed by severe post-partum haemorrhage due to uterine atony (12.7). The case fatality rate was 10.3 where as perinatal mortality rate was 7.7 per 1000 deliveries. The common complication identified intraoperatively was severe haemorrhage which accounted for 39.4 where as intensive care unit admissions (14.4) and febrile morbidity (12.4) were common after the operation. Blood was ordered in all cases but in 31 cases it was indicated that it was not available. Seventy nine patients received blood transfusion with the maximum number of units given to one patient being eight. Twenty two patients were given fresh frozen plasma (FFP); the median number of units given was two (range = 1- 6). In conclusion; emergency peripartum hysterectomy is a life saving procedure and very common at MNH. The most common indication was ruptured uterus followed by severe postpartum haemorrhage. More than half of the patients underwent emergency peripartum hysterectomy were referred from other health facilities with ruptured or suspected ruptured uterus. The procedure was associated with unacceptably high maternal and perinatal morbidity and mortality

Qualitative study on maternal referrals in rural Tanzania: Decision making and acceptance of referral advice

The aim of this study was to describe perceptions of maternal referrals in a rural district in Tanzania. Focus group discussions (FGDs) with health workers and community members, stratified by age and gender, were conducted. The FGDs revealed that husbands and relatives are the decision makers in maternal referrals, whereas the women had limited influence, especially on emergency referrals. The process in deciding to seek referral care is envisaged within community perception of seriousness of the condition, difficulty to access and cost involved in transport, living expenses at the hospital, and perceived quality of care at facility level. The hospitals were seen as providing acceptable quality of care, whereas, the health centres had lower quality than expected. To improve maternal referral compliance and reduce perinatal and maternal morbidity and mortality, community views of existing referral guidelines, poverty reduction, women's empowerment and male involvement in maternal care are necessary. (Afr J Reprod Health 2008; 12[2]:120-131)