Doctors with Africa Cuamm Mothers and Children First: the first steps - Tanzania Info: www.doctorswhithafrica.org
Tanzania, Iringa District Council
per 1,000 live births (48,125 deaths per year). • Stillbirth rate is 25.6 per 1,000 live births (47,550 deaths per year).
Morogoro
Dar es Salaam
Mikumi Iringa Lugarawa Ludewa
National health statistics • 33.4 % of the population lives under the poverty threshold of 1.25 USD per day. • Maternal mortality rate is 458 per 100,000 live births (13,000 maternal deaths per year). • Under five mortality rate is 42 per 1,000 live births (84,693 deaths per year). • Neonatal mortality rate is 25
National health policies and data • 37 healthcare personnel per 10,000 inhabitants. • Per capita health expenditure is 73 USD (World Health Statistics 2012). • The National health plan includes a safe motherhood programme. • The decentralization process of the healthcare system is under way and include also the strengthening of maternal peripheral units. • A programme at national level is being implemented that shortens the training period and allows for a bigger number of midwives to be trained.
level: free transport and management of obstetric emergencies, equipment and drug’s supply, local human resources capacity building. • Expatriate Personnel (Doctors with Africa Cuamm): n. 1 internal medicine, n. 1 paediatrician, n. 1 public health expert.
Intervention in Iringa District Council and Tosamaganga Hospital • The population living in the catchment area of the hospital is 274,417 inhabitants (n. of expected deliveries 8,500). • Health facilities: n. 6 maternal peripheral units and n. 1 Hospital in Tosamaganga (property of the Diocese of Iringa; 160 beds). • Services offered at district
Tools: World Bank 2007 Tanzania Demographic Health Survey 2011 World Health Statistics 2012
Activities implemented in 2012 (first year of the project)
N. of skilled attened deliveries (over the expected in the District)
7,657 (90%)
N. of normal deliveries attended at Tosamaganga Hospital N. of caesarean sections
646
Proportion of caesarean sections and number of expected births (5-15% standard)
N. of ambulance emergency transports N. of healthcare personnel trained on obstetric and neonatal emergencies
0.6%
Proportion of maternal deaths for indirect causes at hospital level
60%
Available service Unavailable service
1 Parenteral administration of antibiotics
–
Services 1 - 7 Basic essential obstetric and neonatal care / BEmOC Basic Emergency
–
Services 1 - 9 Comprehensive essential obstetric and neonatal care / CEmOC
Tosamaganga Hospital Health Centre 1 Health Centre 2 2 Parenteral administration of oxytocin
Health Centre 4 Health Centre 5 Health Centre 6
Iringa DC District, Tanzania
9 Cesarean section
3 Removal of retained products of conception
4 Manual removal of placenta
8 Blood transfusion
7 Assisted vaginal delivery with vacuum or forceps
5 Newborn resuscitation with mask and ambubag 6 Parenteral administration of anticonvulsants
7.6% 178
Figure 1. Essential obstetric and neonatal emergency care 1
Health Centre 3
2,174
1
Tool used: Need assessment of emergency and neonatal care, Columbia University, AMDD 2011.
Doctors with Africa Cuamm Mothers and Children First: the first steps - Tanzania Info: www.doctorswhithafrica.org
Figure 2. Quality of mother and neonatal healthcare services 2
0.5
1
Availability of equipment and consumables
Infrastructure
0 - 0.9 Sustantial improvements are needed in order to avoid serious threats to mothers and newborn health.
2.66 Laboratory diagnostics availability
2.4
1.17
Availability of drugs
Statistics
1
0.1
Maternal unit
Nursery Unit
2-3 Improvements are needed in order to minimize potential threats to health of mothers and newborns while respecting their dignity and rights.
0.88
1 Access to hospital healthcare
Tosamaganga Hospital Tanzania
0.5 Guidelines and auditing procedures
1 - 1.9 Improvements are necessary in order to avoid risks for women and newborn.
Normal labour
1.1 Cesarean Sections
0.75
1
Monitoring and follow up
Management of maternal complications
1.5
0.1
Management of emergencies
1.75
Sick Newborn care
Infection control and supportive care
0.3 2
Tool used: Assessment tool for the quality of hospital care for mothers, newborn and child, WHO 2009.
Routine neonatal care
Figure 3. Socio-economic profile of women delivering at hospital level and health centres at district level 3
– 41% of women who deliver at Tosamaganga Hospital belong to the wealthiest quintile of the population.
100%
– 80%
– Only 17% belongs to the last two quintiles.
60%
41 40%
24 20%
17 11 6
0% Quintile 5
Quintile 4
Q Quintile 3
Quintile 2
wealthiest
Quintile 1
poorest
3
Tool used: Proxy Wealth Index, Cuamm Household Health Survey Iringa DC 2009