Abstract
BackgroundIn 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.MethodThis 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.ResultsDeliveries with skilled attendant significantly increased from 34.1% to 51.4% (ρ < 0.05). Early ANC booking (4 to 16 weeks) rose significantly from 18.7% at baseline to 37.7% in 2005 and 56.9% (ρ < 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.ConclusionThe 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.
Highlights
In Tanzania, maternal mortality ratio remains unacceptably high at 578/100,000 live births
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
Intervention impact on place of delivery and skilled attendance With respect to our primary outcome, the results show a significant improvement in the utilization of a skilled attendance with variation across the villages
Summary
In Tanzania, maternal mortality ratio remains unacceptably high at 578/100,000 live births. While in Tanzania 72% of the population are residing within 5 km and 90% within 10 km of a health facility which provides delivery care, physical accessibility of health facilities does not automatically increase utilization of professional delivery care This is especially true in rural communities where a mix of socio-cultural, personal, economic and health service factors stand as main barriers [9,10,11,12]. Training of change agents who are commonly known as community volunteers or peers [9,14,18,19,20] is an important element in most community based health interventions Their tasks and activities included specific maternal health activities such as follow-up of pregnant women, providing education on danger signs, risk factors, and birth preparedness plans, counselling, to facilitate referrals and advocacy to influence or demand better obstetric care or health services [21,22,23]. Coverage of skilled delivery attendance, a key indicator for the Millennium Development Goal 5 (Reduce maternal mortality) [24] was used as primary study outcome
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