Maternal and Child Health Journal

, Volume 19, Issue 1, pp 155–169 | Cite as

Skilled Birth Attendants in Tanzania: A Descriptive Study of Cadres and Emergency Obstetric Care Signal Functions Performed

  • Etsuko Ueno
  • Adetoro A. Adegoke
  • Gileard Masenga
  • Janeth Fimbo
  • Sia E. Msuya
Article

Abstract

Although most developing countries monitor the proportion of births attended by skilled birth attendants (SBA), they lack information on the availability and performance of emergency obstetric care (EmOC) signal functions by different cadres of health care providers (HCPs). The World Health Organisation signal functions are set of key interventions that targets direct obstetric causes of maternal deaths. Seven signal functions are required for health facilities providing basic EmOC and nine for facilities providing comprehensive EmOC. Our objectives were to describe cadres of HCPs who are considered SBAs in Tanzania, the EmOC signal functions they perform and challenges associated with performance of EmOC signal functions. We conducted a cross-sectional study of HCPs offering maternity care services at eight health facilities in Moshi Urban District in northern Tanzania. A questionnaire and health facility assessment forms were used to collect information from participants and health facilities. A total of 199 HCPs working at eight health facilities in Moshi Urban District met the inclusion criteria. Out of 199, 158 participated, giving a response rate of 79.4 %. Ten cadres of HCPs were identified as conducting deliveries regardless of the level of health facilities. Most of the participants (81 %) considered themselves SBAs, although some were not considered SBAs by the Ministry of Health and Social Welfare (MOHSW). Only two out of the eight facilities provided all of the required EmOC signal functions. While Assistant Medical Officers are expected to perform all the signal functions, only 38 % and 13 % had performed vacuum extraction or caesarean sections respectively. Very few registered and enrolled nurse-midwives had performed removal of retained products (22 %) or assisted vaginal delivery (24 and 11 %). Inadequate equipment and supplies, and lack of knowledge and skills in performing EmOC were two main challenges identified by health care providers in all the level of care. In the district, gaps existed between performance of EmOC signal functions by SBAs as expected by the MOHSW and the actual performance at health facilities. All basic EmOC facilities were not fully functional. Few health care providers performed all the basic EmOC signal functions. Competency-based in-service training of providers in EmOC and provision of enabling environment could improve performance of EmOC signal functions in the district.

Keywords

Skilled birth attendant Emergency obstetric care Signal functions Tanzania Sub-Saharan Africa 

Abbreviations

ACO

Assistant Clinical Officer

AMO

Assistant Medical Officer

BEmOC

Basic Emergency Obstetric Care

CEmOC

Comprehensive Emergency Obstetric Care

CO

Clinical Officer

EmOC

Emergency Obstetric Care

ENM

Enrolled Nurse/Midwife

HCP

Health care provider

IQR

Interquartile range

KCMC

Kilimanjaro Christian Medical Centre

KCMU-Co

Kilimanjaro Christian Medical University College

LSTM

Liverpool School of Tropical Medicine

MCHA

Maternal and Child Health Aide

MDG

Millennium Development Goal

MMR

Maternal mortality ratio

MNHU

Maternal and Newborn Health Unit

MOHSW

Ministry of Health and Social Welfare

PHN

Public Health Nurse

RCH

Reproductive and Child Health

RNM

Registered Nurse/Midwife

SBA

Skilled birth attendant

SD

Standard deviation

SPSS

Statistical Package for Social Science

UNICEF

United Nations Children’s Fund

WHO

World Health Organisation

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Copyright information

© Springer Science+Business Media New York 2014

Authors and Affiliations

  • Etsuko Ueno
    • 1
  • Adetoro A. Adegoke
    • 1
  • Gileard Masenga
    • 2
  • Janeth Fimbo
    • 3
  • Sia E. Msuya
    • 1
  1. 1.Liverpool School of Tropical MedicineLiverpoolUK
  2. 2.Department of Obstetrics and GynaecologyKCMC Hospital and KCMU CollegeMoshiTanzania
  3. 3.Reproductive and Child Health UnitMoshi Municipal CouncilMoshiTanzania

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