Bypassing primary care clinics for childbirth: a cross-sectional study in the Pwani region, United Republic of Tanzania

Kruk, Margaret E; Hermosilla, Sabrina; Larson, Elysia; Mbaruku, Godfrey

doi:10.2471/blt.13.126417

Cited by 112 publications

(179 citation statements)

References 24 publications

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“…Study site selection was described previously. [5] Eligible women were identified via enumeration of all households within the government-designated catchment areas of 24 study facilities. Women were eligible if they were at least 15 years old, lived in the catchment area, and had delivered a baby within one year prior to interview.…”

Section: Methodsmentioning

confidence: 99%

Missed Opportunities to Improve the Health of Postpartum Women: High Rates of Untreated Hypertension in Rural Tanzania

Larson

Rabkin

Mbaruku

et al. 2017

Matern Child Health J

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Objectives To assess the prevalence of high blood pressure amongst postpartum women in rural Tanzania, and to explore factors associated with hypertension prevalence, awareness of their own hypertension, treatment, and control. Methods We conducted a cross-sectional study of 1,849 women in Tanzania’s Pwani Region who delivered a child in the prior year. We measured blood pressure, administered a structured questionnaire, and assessed factors associated with hypertension (HTN) prevalence, women’s awareness of their own HTN, treatment, and control of HTN using bivariable and multivariable logistic regressions. Findings 26.7% of women had high blood pressure and/or were taking antihypertensive medication. Women were on average 27.5 years old (range 15–54). Nearly all women (99.5%) reported contact with the health system during their pregnancy and delivery, with 97.0% reporting at least one antenatal care visit, 81.4% reporting facility delivery, and an overall average of 5.2 visits for their own care in the past year. Only 23.5% of those with HTN were aware of their diagnosis, 17.4% were taking medication, and only 10.5% had controlled blood pressure. In multivariable analysis, facility delivery, health insurance, and increased distance from a hospital were associated with increased likelihood of HTN awareness; facility delivery and hospital distance were associated with current hypertensive treatment; younger age and increased hospital distance were associated with control of HTN. Conclusion The prevalence of high blood pressure in this postpartum population was high, and despite frequent recent contacts with the health system, awareness, treatment and control of HTN were low. These findings highlight an important missed opportunity to improve women’s health during antenatal and postnatal care.

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Section: Methodsmentioning

confidence: 99%

Missed Opportunities to Improve the Health of Postpartum Women: High Rates of Untreated Hypertension in Rural Tanzania

Larson

Rabkin

Mbaruku

et al. 2017

Matern Child Health J

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“…During the most recent national census, Pwani Region and the two wards had a total population of 1 098 668 and 27 356, respectively [11] . Economically, the people in this region, like in other rural regions of Tanzania, remain extremely poor and are characterized by poor hospital infrastructure including equipment [12] . Nevertheless, the community in these two wards relied on one referral public district (Utete) hospital, one private (Mchukwi) hospital, two health centres and several public and private dispensaries for their hospital needs.…”

Section: Short Communicationsmentioning

confidence: 99%

Level and Correlates of Self-medication among Adults in a Rural Setting of Mainland Tanzania

Kazaura¹

2017

pharmaceutical-sciences

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A descriptive cross-sectional study was conducted to estimate the proportion of adults practicing selfmedication in a rural setting of Tanzania. Using a structured interview schedule, we interviewed adults (aged at least 18 years) living in two selected wards. Data analysis involved descriptive statistics and logistic regression analysis. Among 474 study participants, 364 (76.8%) reported having experienced illnesses during the past three months before the survey. Among these, 236 (64.8%) reported having practiced self-medication. The main reported reason behind this practice was lack of money to consult a medical doctor. The major reported self-medication drugs include antipyretics 167 (58.2%), analgesics 162 (56.4%) and antimalarials 118 (41.1%). Use of antibiotics was reported by 51 (17.8%) participants. Self-medication was significantly associated with sex, education status and occupation of the respondent. Males had almost twice odds to practice self-medication as compared to females, Adjusted odds ratio was 1.9 (95% confidence interval, 1.1-3.4). Also, respondents with incomplete primary education had about four odds to practice self-medication than those without formal education. Although there were few participants reporting use of antibiotics, we recommend health educators to enhance understanding of benefits and possible risks associated with selfmedication. Also, we recommend a study to examine the attitudes associated with self-medication practices.

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“…Consumers of maternity services are becoming increasingly aware with regard to expectations of quality, with some women in LMICs even bypassing more easily accessible, local primary care clinics in search of higher-quality care at secondary and tertiary level facilities [9]. Perceptions surrounding the quality of care that will be received in a facility impact a woman’s initial decision to deliver in a facility, in addition to whether she will access institutional delivery for subsequent births [6,7,10].…”

Section: Introductionmentioning

confidence: 99%

Do women’s perspectives of quality of care during childbirth match with those of providers? A qualitative study in Uttar Pradesh, India

Bhattacharyya

Srivastava

Saxena

et al. 2018

Global Health Action

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Background: Persistently high maternal mortality levels are a concern in developing countries. In India, monetary incentive schemes have increased institutional delivery rates appreciably, but have not been equally successful in reducing maternal mortality. Maternal outcomes are affected by quality of obstetric care and socio-cultural norms. In this light there is need to examine the quality of care provided to women delivering in institutions. Objective: This study aimed to examine pregnant women’s expectations of high-quality care in public health facilities in Uttar Pradesh, India, and to contrast this with provider’s perceptions of the same, as well as the barriers that limit their ability to provide high-quality care. Methods: A qualitative descriptive analysis was conducted on data from two studies – focus group discussions with rural women in their last trimester of pregnancy (conducted in 2014) to understand women’s experience and satisfaction with maternal care services, and in-depth interviews with care providers (conducted in 2016–17) to understand provision of person-centred care. Provider perspectives were matched with themes of women’s perspectives on quality of childbirth care in facilities. Results: Major themes of care prioritised by women included availability of doctors at the facility; availability of medicines; food; ambulance services; maintenance of cleanliness and hygiene; privacy; good and safe delivery with no complications; client-provider interaction; financial cost of care. Many women also voiced no expectation of care, indicating disillusionment from the existing system. Providers concurred with women on all themes of care except availability of doctors, as they felt that trained nurses were proficient in conducting deliveries. Conclusions: This study shows that women have clear expectations of quality care from facilities where they go to deliver. Understanding their expectations and matching them with providers’ perspectives of care is critical for efforts to improve the quality of care and thereby impact maternal outcomes.

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Bypassing primary care clinics for childbirth: a cross-sectional study in the Pwani region, United Republic of Tanzania

Cited by 112 publications

References 24 publications

Missed Opportunities to Improve the Health of Postpartum Women: High Rates of Untreated Hypertension in Rural Tanzania

Missed Opportunities to Improve the Health of Postpartum Women: High Rates of Untreated Hypertension in Rural Tanzania

Level and Correlates of Self-medication among Adults in a Rural Setting of Mainland Tanzania

Do women’s perspectives of quality of care during childbirth match with those of providers? A qualitative study in Uttar Pradesh, India

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