Sexual History and Contraception among Women with Indused and Spontaneous Abortion in Dar es Salaam

The objective of this study was to create sexual history profiles of women with illegally induced abortion (IA) and women with spontaneous abortion (SA) and describe the women's knowledge of; attitude to; and practice of contraception. The study was carried out in two settings; Temeke District Hospital (TDH) and Muhimbili Medical Centre (MMC) in Dar es Salaam. At TDH 362/603 (60 per cent) were identified as IA and 241/603 (40 per cent) as SA. At MMC the figures were 68/220 (31 per cent) IA and 152/220 (69 per cent) SA. Both groups were well informed about modern contraception. As a contrast the rate of ever users of contraception was low in both groups; although significantly lower among IA women than among SA women. Outcome of first pregnancy had been an induced abortion in significantly higher proportion of IA than of SA women. In conclusion; sexual intercourse before marriage is common in the setting studied and contraceptive use in comparatively uncommon

Anaemia in Pregnancy : a Major Health Problem with Implications for Material Health Care

Women (n=2235) registering for antenatal care in two maternal and child health clinics in the Dar es Salaam area between June; 1991 and June 1992 had their haemoglobin (Hb) measured by use of a HaemoCuer haemoglobinometer. The prevalence of anaemia Hb10.5 g/dl) was 60while severe anaemia (Hb7.0 //dl) was present in 4. Young nullparous women; those who register for antenatal care late in the third trimester; and undernourished women constitute high risk groups also for severe anemia and require special attention. No single maternal characteristics or combination thereof was useful to identify a group of screening. The current national Hb level for referral to hospital (8.5 g/dl) identified 20of the pregnant population. Most of these can successfully be treated and followed at the primary care level. To comply with the available means for care in the Dar es Salaam area; it is proposed that the cutoff level for referral be changed to 7g/dl. Appropriate methods to screen for anemia at primary health care (PHC) level must be explored and instituted. Training of antenatal care (ANC) providers in clinical identification of anemia and supply of haematinics must be improved and early booking for ANC promoted. Public health measures to improve the general nutrition and iron intake of all women are necessary to reduce this serious health problem in pregnancy

Maternal mortality in Dar es Salaam; Tanzania: Socio-economic; obstetric history and accessibility of health care factors

A community-based incident case-referent study was performed in Ilala district; Dar es Salaam; Tanzania to estimate the social; obstetric history and accessibility of health care factors for maternal death. From February 1991 to January 1993 all female deaths in the reproductive ages were identified through the existing administrative information system. For every maternal death three live mothers was selected as referents matched for age. In cases a relative to the deceased mother and in referents the live mother herself was interviewed using a pretested questionnaire. Socio-economic factors were strongly related to the risk of maternal death. Single and divorced women were at an increased risk (odds ratio (OR) =5.1; 95 per cent confidence interval (CI): 2.8-9.3 and OR=28; 95 per cent CI: 6.5-118). Women with less than 3 years' education had a 3 fold higher risk than women with more than 7 years' schooling. Also women who were peasants and unskilled workers were at higher risk when compared with professionals and peasants and unskilled workers were at higher risk when compared with professionsls and skilled workers (OR=20; 95 per cent CI:7.4-51). An obstetric history with no previous live births (OR=36; 95 per cent CI: 8.239); more than one induced abortion (OR=36; 95 per cent CI; 9.7-132) or stillbirth (OR=4.8; 95 per cent CI:1.6-14) and unwanted pregnancy (OR=4.0; 95 per cent CI: 2.2-7.3) were; as expected; statistically significant risk factors for maternal death. Factors reflecting living standards such as type of housing; access to tap-water and electricity; availability of a toilet and the living standard as estimated by the interviewer were all statiscally significant for the risk of maternal death (OR=7.2; 2.7; 2.1; 8.3 and 6.2; respectively). Increased distance in meters from the house to a road and increased time in minutes taken to reach the nearest transport; clinic and hospital in minutes increased the risk for a maternal death significantly. The preventive activities require efforts from the whole community. The health care system can contribute by early identification of risk cases. e.g. women with previous stillbirths and miscarriages in the antenatal care