Developing and evaluating strategies to reduce maternal and perinatal mortality and morbidity in
Tanzania
Project description:
Background: Each year almost 3 million babies are born dead and just as many die within the first month of
life, while over a quarter of a million women die due to pregnancy and child birth. This totals more than the
number of deaths caused by HIV/AIDS, Tuberculosis and Malaria together. Newborn surviving a
complicated birth may suffer lifelong disabilities like cerebral palsy, learning disorders or an increased risk
of chronic, non-communicable diseases.
A number of studies have demonstrated how health systems in developing countries widely fail to provide
safe delivery care as the quality of Basic Emergency Obstetric and Neonatal Care is severely deficient or
absent. Efforts to improve emergency care such as skills training, task shifting, criterion based audit and the
promotion of outreach friendly drugs like misoprostol have proven effective. Tanzania is among the ten
countries in the world with the highest numbers of maternal deaths and one of the sub-Saharan African
countries with the highest perinatal mortality. There have only been minor reductions in mortality figures
over the last decades even though mother-and-child health services are provided at no costs. Our research
in Tanzania has previously shown that the quality of EmONC can be improved through ALSO training and
criterion-based audits.
Advanced Life Support in Obstetrics (ALSO)
ALSO is the most widely taught EmONC training course and the concept was introduced to Tanzania in 2008
as a collaboration between University of Copenhagen, Duke University, Kagera Regional Hospital and
Kilimanjaro Christian Medical Centre. The ALSO program in Tanzania is based at KCMC and 61 ALSO
provider courses have been conducted by 37 Tanzanian instructors with the participation of more than
1500 health providers. The course has been thoroughly revised to meet the most important causes of
maternal and neonatal mortality with the diagnostic and therapeutic means available.
Criterion Based Audit
Criterion based audit is a ‘circular’ process to map and address substandard care. The audit results point
out focal points for quality improvement and gives ‘objective’ feedback to health providers. When repeated
over time the audit process can document progress and be motivating and encouraging for staffs to
improve further
Objectives:
The overall objective of the program is to further develop and evaluate efforts to improve the quality of
EmONC in a collaboration between researchers and health professionals from Tanzania, Denmark and the
United States of America.
Specific objectives are:
1) To disseminate, evaluate and develop the ALSO program that was established in 2008 as a
collaboration between Kilimanjaro Christian Medical Centre, Tanzania, Duke University, NC, USA
and University of Copenhagen, Denmark.
2) To further develop criterion based audit tools for the most important causes of maternal and
perinatal mortality and morbidity