12 January 2013

Tanzania: Clinical Assessment Vital for Curbing Nation's Mother and Child Mortality

Photo: Nyani Quarmyne/UNICEF
A girl and her mother, in Niger.

HEALTH experts in the country are vouching for the introduction of clinical audits in all health facilities as a measure to reduce maternal and child deaths. The World Lung Foundation (WLF) Project Director, Prof Staffan Bergstrom, told the 'Daily News on Saturday' that the introduction of these audits in the health centres they operate have helped check on unjustified C-Section operations.

"Clinical audit demands an exemplary organisation of the labour ward book and of all patient's case notes and records, above all partograms and theatre notes on anaesthesia and surgery, if the Ministry of Health and Social Welfare ensured this is done, a lot can be achieved," he said. Prof Bergstrom said that clinical audit primarily aims at detecting mismanagement and degree of avoiding adverse outcomes of clinical management.

He said that with the many temptations that exist among health personnel and the low salaries, in the three regions of Kigoma, Morogoro and Coast regions where they operate, they had witnessed a lot of unnecessary C-Sections being conducted. "A lot of people don't know this but C-Sections is very costly because of the extra surgical, anaesthetic and other materials used, as well as the health of the mothers.

We are seeing an increase in C-Sections demand by wealthy people and doctors wanting to make extra cash, this is scientifically sound," he explained. Prof Bergstrom said that another vital tool needed in the reduction of maternal and child deaths was having one person accountable for labour wards, saying that with the lack of staffing, the person in charge of the ward has other roles to play.

He said that lack of accountability in many labour wards in the country was a huge stumbling block that needed to be addressed quickly because it made the work of specialists, coming to help, almost impossible. "You can have all the ward attendants, surgical gloves, anaesthesia and other operation and delivery equipment but without a commander of the ward, these efforts add up to very little," he said.

According to the WLF 2011 report, in the health facilities where they operate, more than 21,000 deliveries were attended and among them almost 2,400 were caesarean sections. Comparing two years, 2010 and 2011, there had been tangible increase in deliveries attended, where Kigoma's increase amounted to 16 per cent, Morogoro 42 per cent and Coast 10 per cent.

The report cited that in 2010-2011 the maternal mortality ratios decreased significantly in WLF supported facilities where Kigoma recorded a decrease from 347 to 293, Morogoro 345 to 219 and Coast from 507 to 359. The Deputy Minister for Health and Social Welfare, Dr Seif Rashid, said that maternal death was increasingly being recognised as a human rights violation and that it was one MDG unlikely to be attained by 2015.

Dr Rashid said that neonatal mortality was still contributing to half of all infants' deaths and therefore needed more efforts to further improve the survival of these newborn infants. "We appreciate the efforts by WLF which is actively participating in and executing comprehensive emergency obstetric care (CEmOC) in most remote rural areas of the country, where maternal mortality is high," he said.

The deputy minister said that since 2008, WLF had actively upgraded, renovated or rebuilt health facilities to safeguard the existence of life saving CEmOC. He said that though there were over 600 facilities in the country, WLF's efforts of renovating 12 health centres, 10 maternity wards, five laboratories, 11 operation theatres and building 20 staff houses had made significant impact.

The Morogoro Regional Project Officer, Dr Angelo Nyamtema, said that between January and February 2012, 40 per cent of the C-Sections deliveries in WLF supported facilities were unjustified but after monthly auditing by October they achieved a near 75 per cent of justified deliveries. Dr Nyamtema cited inadequate documented case files, misplacement of patient's files, misconception of the usage vacuum extractors and inadequate involvement of district health authorities in the auditing process as major hurdles.

Coast Regional Project Officer, Dr Clementina Kairuki echoed the challenges adding that at Kibiti health centre, between January and December 2012, they accounted for 60 per cent of C-Section deliveries that were unjustified and done without clear indication, a situation that was worrying them.

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