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.
Similar content being viewed by others
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
References
WHO (2012) MDG 5: improve maternal health. http://www.who.int/topics/millennium_development_goals/maternal_health/en/index.html.
Ronsmans, C., & Graham, W. (2006). Maternal mortality: Who, when, where and why. Lancet, 368, 1189–1200.
WHO, Unicef. (2010). Countdown to 2015 decade report (2000–2015): taking stock of maternal, newborn and child survival. Geneva, Switzerland: WHO and UNICEF. 2010.
UNICEF (2008) Fact of the week , http://www.unicef.org/factoftheweek/index_46985.html.
WHO (2009) Monitoring emergency obstetric care. A handbook. WHO, UNFPA, UNICEF & AMDD. Geneva, Switzerland: WHO press. http://whqlibdoc.who.int/publications/2009/9789241547734_eng.pdf.
Campbell, O. M. R., & Graham, W. (2006). Strategies for reducing maternal mortality: Getting on with what works. Lancet, 368, 1284–1299.
Bullough, C., Meda, N., Makowiecka, K., Ronsmans, C., Achadi, E. L., & Hussein, L. (2005). Current strategies for the reduction of maternal mortality. BJOG, 112(9), 1180–1188.
Paxton, A., Bailey, P., Lobis, S., & Fry, D. (2006). Global patterns in availability of emergency obstetric care. International Journal of Gynaecology and Obstetrics, 93, 300–307.
Van Lerberghe, W., & De Brouwere, V. (2001). Of blind alleys and things that have worked: History’s lessons on reducing maternal mortality. Studies in Health Services Organisation and Policy, 17, 7–33.
Paxton, A., Maine, D., Freedman, L., Fry, D., & Lobis, S. (2005). The evidence for emergency obstetric care. International Journal of Gynaecology and Obstetrics, 88, 181–193.
WHO. (2004). Making pregnancy safer: the critical role of the skilled attendant. A joint statement by WHO, ICM and FIGO. Geneva, Switzerland: WHO press.
International Confederation of Midwives (ICM) (2010). Essential competencies for basic midwifery practice. www.internationalmidwives.org.
Bernis, L. D., Sherrat, D. R., AbouZahr, C., & Lerberghe, W. V. (2003). Skilled attendants for pregnancy, childbirth and postnatal care. British Medical Bulletin, 67, 39–57.
Scott, S., & Ronsmans, C. (2009). The relationship between birth with a health professional and maternal mortality in observational studies: A review of literature. Tropical Medicine & International Health, 14(12), 1523–1533.
National Bureau of Statistics (NBS). (2005). Tanzania Demographic and Health Survey 2004–2005. Dar -es- Salaam, Tanzania: NBS and ORC Macro.
National Bureau of Statistics (NBS). (2010). Tanzania Demographic and Health Survey 2010. Dar -es- Salaam, Tanzania: NBS and ORC Macro. 2011.
WHO (2011) World Health Statistics, http://www.who.int/whosis/whostat/2011/en/index.html.
Ministry of Health and Social Welfare (2008) The national road map strategic plan to accelerate reduction of maternal, newborn and child health in Tanzania 2008–2015. http//hdptz.esealtd.com/fileadmin/documents/Key Sector Documents/MNCH/One MNCH plan.pdf.
HSSE: Expectation of doctors and mid-level providers: alignment of regulation, training, and actual performance of emergency obstetric care by health care providers in Malawi and Tanzania 2009, http://www.amddprogram.org/d/sites/default/files/Expectations_MDs_and_MLPs.pdf.
Adegoke, A., Utz, B., Msuya, S. E., & van den Broek, N. (2012). Skilled birth attendants: Who is who? A descriptive study of definitions and roles from nine Sub Saharan African countries. PLoS ONE, 7(7), e40220. doi:10.1371/journal.pone.0040220.
Lobis, S., Mbaruku, G., Kamwendo, F., & McAuliffe, E. (2011). Expected to deliver: alignment of regulation, training and actual performance of emergency obstetric care providers in Malawi and Tanzania. International Journal of Gynecology and Obstetrics, 115, 322–327.
MOHSW. Staffing levels for Ministry of Health and Social Welfare Departments, health facilities and health training institutions. Dar es Salaam, Tanzania. 2012.
Report, Moshi Urban Annual. (2010). Ripoti ya mama na mtoto katika manispaa ya Moshi. Tanzania: Department of Health, Moshi Municipal Council.
Kruk, M. E., Wladis, A., Mbembati, N., Ndao-Brumblay, S., Hsia, R., Galukande, M., et al. (2010). Human resource and funding constraints for essential surgery in district hospitals in Africa: A retrospective cross-sectional survey. PLoS Medicine, 7(3), e1000242.
WHO. (2006). The World Health Report 2006—Working together for health (p. 26). Geneva, Switzerland: WHO.
Ameh, C., Adegoke, A., et al. (2012). The impact of emergency obstetric care training in Somaliland, Somalia. International Journal of Gynaecology and Obstetrics, 117(3), 283–287.
Pearson, L., & Shoo, R. (2005). Availability and use of emergency obstetric services: Kenya, Rwanda, Southern Sudan, and Uganda. International Journal of Gynecology and Obstetrics, 88(2), 208–215.
Kongnyuy, E. J., Hofman, J., Mlava, G., Mhango, C., & van den Broek, N. (2009). Availability, utilisation and quality of basic and comprehensive emergency obstetric care services in Malawi. Maternal and Child Health Journal, 13, 687–694.
Ameh, C., Msuya, S. E., Hofman, J., Raven, J., Mathai, M., & Van den Broek, N. (2012). Status of emergency obstetric care in six developing countries 5 years before the MDG targets for maternal and newborn health. PLoS ONE, 7(12), e49938. doi:10.1371/journal.pone.0049938.
Ziraba, A. K., Mills, S., Madise, N., Saliku, T., & Fotso, J.-C. (2009). The state of emergency obstetric care services in Nairobi informal settlements and environs: Results from maternity health facility survey. BMC Health Service Research, 9, 46.
van Lonkhuijzen, L., Dijkman, A., van Roosmalen, J., Zeeman, G., & Scherpbier, A. (2010). A systematic review of the effectiveness of training in emergency obstetric care in low-resource environments. BJOG: An International Journal of Obstetrics & Gynaecology, 117(7), 777–787.
Kwast, B. E. (1998). Quality of care in reproductive health programmes: Education for quality improvement. Midwifery, 14, 131–136.
Draycott, T., Sibanda, T., Owen, L., Akande, V., Winter, C., Reading, S., et al. (2006). Does training in obstetrics emergencies improve neonatal outcome? BJOG, 113, 177–182.
Black, R. S., & Brocklehurst, P. (2003). A systematic review of training in acute obstetric emergencies. BJOG, 110, 837–841.
Ijadunola, K. T., Fatusi, A. O., et al. (2007). Unavailability of essential obstetric care services in a local government area of south-west Nigeria. Journal of Health, Population and Nutrition, 25, 94–100.
Grady, K., Ameh, C., et al. (2011). Improving essential obstetric and newborn care in resource-poor countries. Journal of Obstetrics and Gynaecology, 31, 18–23.
Sorensen, B. L., Rasch, V., et al. (2011). Advanced life support in obstetrics (ALSO) and post-partum hemorrhage: A prospective intervention study in Tanzania. Acta Obstetrica et Gynecological Scandinavica., 90, 609–614.
Pereira, C., Mbaruku, G., et al. (2011). Emergency obstetric surgery by non-physician clinician in Tanzania. International Journal of Gynecology and Obstetrics, 114, 180–183.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Ueno, E., Adegoke, A.A., Masenga, G. et al. Skilled Birth Attendants in Tanzania: A Descriptive Study of Cadres and Emergency Obstetric Care Signal Functions Performed. Matern Child Health J 19, 155–169 (2015). https://doi.org/10.1007/s10995-014-1506-z
Published:
Issue Date:
DOI: https://doi.org/10.1007/s10995-014-1506-z