Browsing by Author "Kuhn, Susan"

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    Is it home delivery or health facility? Community perceptions on place of childbirth in rural Northwest Tanzania using a qualitative approach
    (2020-05-06) Konje, Eveline T; Hatfield, Jennifer; Kuhn, Susan; Sauve, Reginald S; Magoma, Moke; Dewey, Deborah
    Abstract Background In low and middle-income countries, pregnancy and delivery complications may deprive women and their newborns of life or the realization of their full potential. Provision of quality obstetric emergency and childbirth care can reduce maternal and newborn deaths. Underutilization of maternal and childbirth services remains a public health concern in Tanzania. The aim of this study was to explore elements of the local social, cultural, economic, and health systems that influenced the use of health facilities for delivery in a rural setting in Northwest Tanzania. Methods A qualitative approach was used to explore community perceptions of issues related to low utilization of health facilities for childbirth. Between September and December 2017, 11 focus group discussions were conducted with women (n = 33), men (n = 5) and community health workers (CHWs; n = 28); key informant interviews were conducted with traditional birth attendants (TBAs; n = 2). Coding, identification, indexing, charting, and mapping of these interviews was done using NVIVO 12 after manual familiarization of the data. Data saturation was used to determine when no further interviews or discussions were required. Results Four themes emerge; self-perceived obstetric risk, socio-cultural issues, economic concerns and health facility related factors. Health facility delivery was perceived to be crucial for complicated labor. However, the idea that childbirth was a “normal” process and lack of social and cultural acceptability of facility services, made home delivery appealing to many women and their families. In addition, out of pocket payments for suboptimal quality of health care was reported to hinder facility delivery. Conclusion Home delivery persists in rural settings due to economic and social issues, and the cultural meanings attached to childbirth. Accessibility to and affordability of respectful and culturally acceptable childbirth services remain challenging in this setting. Addressing barriers on both the demand and supply side could result in improved maternal and child outcomes during labor and delivery.
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    Late initiation and low utilization of postnatal care services among women in the rural setting in Northwest Tanzania: a community-based study using a mixed method approach
    (2021-07-02) Konje, Eveline T.; Hatfield, Jennifer; Sauve, Reg; Kuhn, Susan; Magoma, Moke; Dewey, Deborah
    Abstract Background Maternal and newborn mortality is high immediately after childbirth and up to 42 days postnatally despite the availability of interventions. Postnatal care is crucial in preventing mortality and improving the health of women and newborns. This prospective cohort study investigated the initiation and utilization of postnatal care at health facilities and explored users’ and providers’ perspectives on utilization of postnatal care services. Methods A sequential explanatory mixed method was used involving women who were followed from the 3rd trimester of pregnancy to 3–4 months postnatally in Northwest, Tanzania. From January to December 2018, a door-to-door survey was conducted 3–4 months postnatally among 1385 of these women. A convenience sample of women and community health workers participated in focus group discussions, and traditional birth attendants and nurses participated in key informant interviews to complement quantitative data. Data analyses were conducted using STATA version 13 and NVIVO version 12. Study findings Approximately, one half of participants attended postnatal care within 42 days after delivery. Postnatal care seeking within 48 h after delivery was reported by 14.6 % of the participants. Women who attended antenatal care at least four times, delivered at health facilities or experienced delivery-related complications were more likely to seek postnatal care. Limited knowledge on the postnatal care services and obstetric complications after childbirth, and not being scheduled for postnatal care by health providers negatively influenced services uptake. Overwhelming workload and shortages of supplies were reported to hinder the provision of postnatal care services. Conclusions Utilization of postnatal care services remains low in this setting as a result of a number of disparate and complex factors that influence women’s choices. Provision of effective postnatal care is hindered by lack of supplies, staffing, and inadequate infrastructure. To ensure accessibility and availability of quality services in this setting, both demand and supply sides factors need to be addressed.
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    Missed opportunities in antenatal care for improving the health of pregnant women and newborns in Geita district, Northwest Tanzania
    (2018-10-05) Konje, Eveline T; Magoma, Moke T N; Hatfield, Jennifer; Kuhn, Susan; Sauve, Reginald S.; Dewey, Deborah M
    Abstract Background Despite the significant benefits of early detection and management of pregnancy related complications during antenatal care (ANC) visits, not all pregnant women in Tanzania initiate ANC in a timely manner. The primary objectives of this research study in rural communities of Geita district, Northwest Tanzania were: 1) to conduct a population-based study that examined the utilization and availability of ANC services; and 2) to explore the challenges faced by women who visited ANC clinics and barriers to utilization of ANC among pregnant women. Methods A sequential explanatory mixed method design was utilized. Household surveys that examined antenatal service utilization and availability were conducted in 11 randomly selected wards in Geita district. One thousand, seven hundred and nineteen pregnant women in their 3rd trimester participated in household surveys. It was followed by focus group discussions with community health workers and pregnant women that examined challenges and barriers to ANC. Results Of the pregnant women who participated, 86.74% attended an ANC clinic at least once; 3.62% initiated ANC in the first trimester; 13.26% had not initiated ANC when they were interviewed in their 3rd trimester. Of the women who had attended ANC at least once, the majority (82.96%) had been checked for HIV status, less than a half (48.36%) were checked for hemoglobin level, and only a minority had been screened for syphilis (6.51%). Among women offered laboratory testing, the prevalence of HIV was 3.88%, syphilis, 18.57%, and anemia, 54.09%. In terms of other preventive measures, 91.01% received a tetanus toxoid vaccination, 76.32%, antimalarial drugs, 65.13%, antihelminthic drugs, and 76.12%, iron supplements at least once. Significant challenges identified by women who visited ANC clinics included lack of male partner involvement, informal regulations imposed by health care providers, perceived poor quality of care, and health care system related factors. Socio-cultural beliefs, fear of HIV testing, poverty and distance from health clinics were reported as barriers to early ANC utilization. Conclusion Access to effective ANC remains a challenge among women in Geita district. Notably, most women initiated ANC late and early initiation did not guarantee care that could contribute to better pregnancy outcomes.
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    Mycobacterium senegalense Tissue Infection in a Child After Fish Tank Exposure
    (2011-01-01) Talavlikar, Rachel; Carson, Julie; Meatherill, Bonnie; Desai, Shalini; Sharma, Meenu; Shandro, Cary; Tyrrell, Gregory J.; Kuhn, Susan
    The present report describes the first known case of an otherwise healthy child who developed a soft tissue infection due to Mycobacterium senegalense – a pathogen usually found in east Africa that is responsible for infecting various animals. The patient presented with nonhealing wounds after sustaining facial lacerations from the shattered glass of a fish tank. The patient responded well to scar revision and antibiotics, with no subsequent relapse.
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    Not All Pseudomembranous Colitis is Caused by Clostridium difficile
    (2008-01-01) Janvier, Jack; Kuhn, Susan; Church, Deirdre
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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.