Learning from Health Care Workers' Opinions for Improving Quality of Neonatal Health Care in Kilimanjaro Region; Northeast Tanzania

ABSTRACT

Background: There is a higher neonatal mortality rate while the adherence to the existing guidelines is rarely studied in Tanzania. Aim: The aim of this study is to assess the performance of health workers for neonatal health-care. Materials and Methods: Settings - Peripheral health facilities (regional referral; district hospitals and health centers) and a tertiary referral hospital of Kilimanjaro region; Tanzania. Fourteen hospital facilities within all seven districts of the Kilimanjaro region wer involved in this cross-sectional descriptive study. Data were collected for 5 months from 26 th November; 2010 to 25 th April; 2011. We analyzed our quantitative data by using STATA v10 (StataCorp; TX; USA) for statistical comparison using Chi-square test to test the difference between the categories and odds ratio (OR) for association between independent and dependent variables. Results: Birth asphyxia was the most recalled health problem requiring critical care; reported by 27.5 (33/120) of health-care workers (HCWs) at peripheral hospitals and at 46.4 (13/28) in a tertiary referral centers. Majority of HCWs commented on their own performance 47.5 (67/140). In the periphery (40); first comment was on management and follow-up of neonatal cases 47.5 (19/40); second on a need of skills 45 (18/40) and third on timely referrals 7.5 (18/40). Shortage of proper equipment was reported at 26.4 (37/140); shortage of staff was reported at 12.0 (17/140); lack of organization of care 11.4 (16/140) and poor hygiene at 2.9 (4/140). It was hard to judge the impact of training on the sufficiency of knowledge (OR 2.1; 95 confidence interval [0.9 - 4.8]; P = 0.08) although levels of knowledge for critical neonatal care were higher at the tertiary referral hospital (Pearson ?2 [2] = 53.8; P 0.001). Conclusion: Performance of HCWs in early neonatal care is suboptimal and requires frequent systematic evaluation