Browsing by Author "Konje, Eveline"

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    The Context of Maternal and Child Health Services in Northwest Tanzania: Missed Opportunities for Preventing Maternal and Perinatal Mortality in Rural Communities
    (2020-08-10) Konje, Eveline; Dewey, Deborah; Magoma, Moke Tito Nyambita; Hatfield, Jennifer; Kuhn, Susan; Sauve, Reg
    The problem: In low- and middle-income countries, women and newborns are faced with premature death due to the lack of safe and timely antenatal, natal, postnatal and newborn care. In Tanzania, maternal and newborn mortality remains high. Health care across the maternal and child continuum of care is recognized to improve survival among women and newborns; however, there are significant differences between rural and urban areas in quality of services and utilization. The overall aim of this dissertation was to investigate the context of maternal and child health services for preventing maternal and perinatal mortality in rural communities in Geita district Northwest Tanzania. Methods: We conducted a prospective population-based study that involved 1714 pregnant women in their third trimester and followed them to 3-4 months postnatally. A mixed methods study design was utilized to capture quantitative and qualitative data. Different stakeholders, namely women, male partners, traditional birth attendants, community health workers, and nurses in charge of reproductive and child health units participated in focus group discussions and key informant interviews. STATA versions 13 and 15 were used to analyze quantitative data while NVIVO 12 was used for qualitative data. Conclusions: Maternal and child mortality rates in this rural area of Tanzania remained high and delivery at a health care facility is not associated with improved perinatal mortality. Early initiation and uptake of antenatal, natal, and postnatal care are not commonly practiced in this setting due to a complex set of factors at the individual, community, and health facility levels. Accessibility, availability, affordability, and acceptability of effective maternal health care remains a challenge among women in rural Geita district, Tanzania. Provision of effective services across the maternal continuum of care is hindered by lack of supplies, staffing, and inadequate infrastructure as well as sociocultural constructs related to gender roles and normative beliefs surrounding pregnancy and childbirth. These findings suggest that in this rural district in Tanzania there are missed opportunities to prevent maternal and infant mortality and morbidity, and improve maternal and child health outcomes, which could partly explain persisting high mortality among women and newborns.