Effectiveness of community based Safe Motherhood promoters in improving the utilization of obstetric care. The case of Mtwara Rural District in Tanzania

Declare Mushi, Rose Mpembeni, Albrecht Jahn, Declare Mushi, Rose Mpembeni, Albrecht Jahn

Abstract

Background: In Tanzania, maternal mortality ratio remains unacceptably high at 578/100,000 live births. Despite a high coverage of antenatal care (96%), only 44% of deliveries take place within the formal health services. Still, "Ensure skilled attendant at birth" is acknowledged as one of the most effective interventions to reduce maternal deaths. Exploring the potential of community-based interventions in increasing the utilization of obstetric care, the study aimed at developing, testing and assessing a community-based safe motherhood intervention in Mtwara rural District of Tanzania.

Method: This community-based intervention was designed as a pre-post comparison study, covering 4 villages with a total population of 8300. Intervention activities were implemented by 50 trained safe motherhood promoters (SMPs). Their tasks focused on promoting early and complete antenatal care visits and delivery with a skilled attendant. Data on all 512 deliveries taking place from October 2004 to November 2006 were collected by the SMPs and cross-checked with health service records. In addition 242 respondents were interviewed with respect to knowledge on safe motherhood issues and their perception of the SMP's performance. Skilled delivery attendance was our primary outcome; secondary outcomes included antenatal care attendance and knowledge on Safe Motherhood issues.

Results: Deliveries with skilled attendant significantly increased from 34.1% to 51.4% (rho < 0.05). Early ANC booking (4 to 16 weeks) rose significantly from 18.7% at baseline to 37.7% in 2005 and 56.9% (rho < 0.001) at final assessment. After two years 44 (88%) of the SMPs were still active, 79% of pregnant women were visited. Further benefits included the enhancement of male involvement in safe motherhood issues.

Conclusion: The study has demonstrated the effectiveness of community-based safe motherhood intervention in promoting the utilization of obstetric care and a skilled attendant at delivery. This improvement is attributed to the SMPs' home visits and the close collaboration with existing community structures as well as health services.

References

    1. UNICEF. Tracking progress in maternal, newborn & child survival. Geneva: UNICEF; 2008.
    1. ICM/FIGO. Delivering services and influencing policy: Health care professionals join forces to improve maternal, newborn, and child health. Int J Obstet Gynaecol. 2009;105:271–274. doi: 10.1016/j.ijgo.2009.01.030.
    1. UN. Millennium Declaration. Washington: United Nation; 2000.
    1. National Bureau of Statistics. Tanzania Demographic and Health Survey 2004-05. Dar-Es-Salaam, Tanzania: National Bureau of Statistics & ORC Macro; 2005.
    1. Massawe SN, Urassa EN, Nystrom L, Lindmark G. Anemia in women of reproductive age in Dar-es-Salaam, Tanzania. Anemia in women of reproductive age in Dar-es-Salaam, Tanzania. East Afr Med J. 2002;79:461–466.
    1. Font F, Alonso GM, Nathan R, Lwilla F, Kimario J, Tanner M, Alonso PL. Maternal mortality in a rural district of southeastern Tanzania: an application of the sisterhood method. Int J Epidemiol. 2000;29:107–112. doi: 10.1093/ije/29.1.107.
    1. National Bureau of Statistics {Tanzania} & Macro International Inc. 1997. Tanzania Demographic and Health Survey 1996. Calverton, Maryland: Bureau of Statistics & Macro International; 1996.
    1. Urassa E, Massawe S, Lindmark G, Nystrom L. Operational factors affecting maternal mortality in Tanzania. Health Policy and Planning. 1997;12:50–57. doi: 10.1093/heapol/12.1.50.
    1. Moore KM. A Behaviour change approach to investigating factors influencing use of skilled care in Home-Bay district, Kenya. Washington, DC: The CHANGE Project/Academy for Education and Development/Manoff Group; 2002.
    1. Thaddeus S, Maine D. Too far to walk: maternal mortality in context. Soc Sci Med. 1994;38:1091–1110. doi: 10.1016/0277-9536(94)90226-7.
    1. Ross RS. Promoting quality maternal and newborn care: A reference manual for program manager. Atlanta: Cooperative for Assistance and Relief Everywhere Inc: CARE; 1998.
    1. Kowalewski M, Jahn A, Kimatta SS. Why do at-risk mothers fail to reach referral level? Barriers beyond distance and cost. Afr J Reprod Health. 2000;4:100–109. doi: 10.2307/3583247.
    1. Rosato M, Laverack G, Grabman L, Tripathy P, Nair N, Mwansambo C, Azad K, Morrison J, Bhutta Z, Perry H. Alma-Ata: Rebirth and Revision 5. Community participation: lessons for maternal, newborn, and child health. Lancet. 2008;372:962–971. doi: 10.1016/S0140-6736(08)61406-3.
    1. Elder J, Ayala G, Harris S. Theories and intervention approaches to health-behavior change in primary care. Am J Prev Medicine. 1999;17:275–284. doi: 10.1016/S0749-3797(99)00094-X.
    1. Kleinman A. Patient and healer in the context of culture. Berkley: University of California Press; 1980.
    1. MotherCare Matters. Behavioural dimension of maternal and survival. A quarterly newsletter and literature review on maternal and neonatal health. 2000. pp. 1–19.
    1. Murray E, Mark J. A Guide to effective care in pregnancy and childbirth. Oxford: Universiry Press; 2000.
    1. Santarelli C. Working with individuals, families and community to improve maternal and newborn health. Geneva: (WHO/FCH/RHR/03.11), World Health Organization; 2003.
    1. WHO. Mother-Baby Package. Implementing Safe Motherhood in developing countries. Geneva: Maternal Health and Safe Motherhood Programme; 1994.
    1. Rifkin SB. Primary health care, community participation and the urban poor: a review of the problems and solutions. Asia-Pacific J Public Health. 1987;1:57–63.
    1. Lankester T. Setting up community-based health program: A practical manual for use in developing countries. 2. London: McMillan Education Ltd; 2000.
    1. Nwakoby B, Akpala C, Nwagbo D, Onah B, Okeke V, Chukudebelu W, Ikeme A, Okaro J, Egbuciem P, Ikeagu A. Community contact persons promote utilization of obstetric services, Anambra State, Nigeria. The Enugu PMM Team. Int J Obstet Gynaecol. 1997;59:219–224. doi: 10.1016/S0020-7292(97)00168-9.
    1. Kiwanuka JS. Reducing maternal deaths in Africa. Brazzavile, Republic of Congo: WHO. Regional Office for Africa; 2003.
    1. United Nation. The Millennium Development Goals Report 2008. Washington; 2008.
    1. Jahn A, Kowalewski M, Kimatta SS. Obstetric care in southern Tanzania: does it reach those in need? Trop Med Int Health. 1998;3:926–932. doi: 10.1046/j.1365-3156.1998.00323.x.
    1. Mushi D, Mpembeni R, Jahn A. Knowledge of school children on maternal health and HIV/AIDS. The case of Mtwara, Tanzania. BMC Pregnancy and Childbirth. 2007;1
    1. Lennon J, Coombs D. Application of the LePSA technique to the health education of leprosy patients. Leprosy Review. 1992;63:145–150.
    1. Werner D, Bower B. Helping health worker learn. 2. Palo Alto, CA: Hesperian Foundation; 1982.
    1. Tanzania Ministry of Health. Tanzanian National Reproductive Health and Communication Strategy and Safe Motherhood Initiatives Massages. Dar es Salaam; 2001.
    1. District Medical Officer. Mtwara District Annual Report. 2006.
    1. Essien E, Ifenne D, Sabitu K, Musa A, Alti-Mu'azu M, Adidu V, Golji N, Mukaddas M. Community loan funds and transport services for obstetric emergencies in northern Nigeria. Int J Obstet Gynaecol. 1997;59:237–244. doi: 10.1016/S0020-7292(97)00171-9.
    1. Lehmann U, Friedman I, Sanders D. Human resources for health and development (JLI Working paper 4-1) Geneva: WHO; 2004. Review of the utilization and effectiveness of community-based health workers in Africa. A Joint learning initiative.
    1. Kendah HB, Leigh B, Kanu MS, Kuteh M, Bangura J, Seisay A. Community motivators promote use of emergency services in Rural Sierra Leon. Int J Obstet Gynaecol. 1997;59:209–218. doi: 10.1016/S0020-7292(97)00167-7.
    1. Nwakoby BN. Use of obstetric services in rural Nigeria. J R Soc Health. 1994;114:132–136. doi: 10.1177/146642409411400304.
    1. Jessop S, Morrissey C, Dusch E, Cox A, Jonas E. MotherCare initiatives: Action and results from 31 projects 1993-2000. Arlington, Va.: John Snow Inc; 2000.
    1. Rowland S. Multiplying light and truth through community health evangelism. Second. Udyog Bhavan, Mumbai: GLS Publishing; 2001.
    1. Kunene B, Beksinska M. Involving men in maternity care: Male in maternity project in South Africa. 2005.
    1. Mullany BC, Becker S, Hindin MJ. The impact of including husbands in antenatal health education services on maternal health practices in urban Nepal: Results from a randomized controlled trial. Health Education Research: Theory and Practice. 2006;22:166–176.
    1. District Medical Officer. Mtwara Rural District annual report 2004. Mtwara Rural District; 2004.
    1. Walraven G, Telfer M, Rowley J, Ronsmans C. Maternal mortality in rural Gambia: levels, causes and contributing factors. Bull World Health Organ. 2000;78:603–613.
    1. Thorogood M, Brittan A. In: Evaluating Health promotion Practice and Method. Coombe Ta, editor. Oxford: Oxford University Press; 2003. Evaluating Interventions-experimental study design in health promotion; pp. 41–56.

Source: PubMed

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