Respectful maternity care delivered within health facilities in Bangladesh, Ghana and Tanzania: a cross-sectional assessment preceding a quality improvement intervention.

OBJECTIVE: To assess respectful maternity care (RMC) in health facilities. DESIGN: Cross-sectional study. SETTING: Forty-three (43) facilities across 15 districts in Bangladesh, 16 in Ghana and 12 in Tanzania. PARTICIPANTS: Facility managers; 325 providers (nurses/midwives/doctors)-Bangladesh (158), Ghana (86) and Tanzania (81); and 849 recently delivered women-Bangladesh (295), Ghana (381) and Tanzania (173)-were interviewed. Observation of 641 client-provider interactions was conducted-Bangladesh (387), Ghana (134) and Tanzania (120). ASSESSMENT: Trained social scientists and clinicians assessed infrastructure, policies, provision and women's experiences of RMC (emotional support, respectful care and communication). PRIMARY OUTCOME: RMC provided and/or experienced by women. RESULTS: Three (20%) facilities in Bangladesh, four (25%) in Ghana and three (25%) in Tanzania had no maternity clients' toilets and one-half had no handwashing facilities. Policies for RMC such as identification of client abuses were available: 81% (Ghana), 73% (Bangladesh) and 50% (Tanzania), but response was poor. Ninety-four (60%) Bangladeshi, 26 (30%) Ghanaian and 20 (25%) Tanzanian providers were not RMC trained. They provided emotional support during labour care to 107 (80%) women in Ghana, 95 (79%) in Tanzania and 188 (48.5%) in Bangladesh, and were often courteous with them-236 (61%) in Bangladesh, 119 (89%) in Ghana and 108 (90%) in Tanzania. Due to structural challenges, 169 (44%) women in Bangladesh, 49 (36%) in Ghana and 77 (64%) in Tanzania had no privacy during labour. Care was refused to 13 (11%) Tanzanian and 2 Bangladeshi women who could not pay illegal charges. Twenty-five (7%) women in Ghana, nine (6%) in Bangladesh and eight (5%) in Tanzania were verbally abused during care. Providers in all countries highly rated their care provision (95%-100%), and 287 (97%) of Bangladeshi women, 368 (97%) Ghanaians and 152 (88%) Tanzanians reported 'satisfaction' with the care they received. However, based on their facility experiences, significant (p<0.001) percentages-20% (Ghana) to 57% (Bangladesh)-will not return to the same facilities for future childbirth. CONCLUSIONS: Facilities in Bangladesh, Ghana and Tanzania have foundational systems that facilitate RMC. Structural inadequacies and policy gaps pose challenges. Many women were, however, unwilling to return to the same facilities for future deliveries although they (and providers) highly rated these facilities.

Practice of emergency obstetric care signal functions and reasons for non-provision among health centers and hospitals in Lake and Western zones of Tanzania.

BACKGROUND: The Lake and Western Zones of Tanzania that encompass eight regions namely; Kagera, Geita, Simiyu, Shinyanga, Mwanza, Mara Tabora and Kigoma have consistently been reported with the poorest Maternal Newborn and Child Health (MNCH) indicators in the country. This study sought to establish the provision of Emergency Obstetric Care (EmOC) signal functions and reasons for the failure to do so among health centers and hospitals in the two zones. METHODS: All the 261 public and private hospitals and health centers providing Obstetric Care services in Lake and Western Zones were surveyed in 2014. Data were collected using questionnaires adapted from the Averting Maternal Deaths and Disabilities (AMDD) tool to assess EmOC indicators. Managers in all facilities were interviewed and services, medicines and equipment were observed. Spatial Mapping was done using a calibrated Global Positioning System (GPS) Essential Software for Android and coordinates represented on digitalized map with Arc Geographical Information System (GIS) software. Population data were according to the 2012 Housing and Population National Census. RESULTS: In total 261 health facilities were identified as providers of Obstetric care services, including 69 hospitals and 192 health centres which constitute an overall facility density of 8 per 500,000 population. The three most common EmOC signal functions available in the 3 months preceding the survey were oxytocics (95.7%), injectable antibiotics (88.9%) and basic newborn resuscitation (83.4%). The lowest proportions of facilities performed Cesarean section (25.7%) and blood transfusion (34.6%). Policy restrictions were the most frequent reasons given in relation to nonperformance of blood transfusion and Cesarean section when needed. Lack of training and supplies were the most common reasons for non availability of assisted vaginal delivery and uterine evacuation. Overall the Direct Case fatality Rate for direct obstetric causes was 3%. The referral system highly depended on hired or shared ambulance. CONCLUSION: The provision of EmOC signal functions in Lake and Western zones of Tanzania is inconsistent, being mainly compromised by policy restrictions, lack of supplies and professional development, and by operating under lowly developed referral services.

Migration for obstetric care: the impact of regional Obstetric Care Facility Density disparities in Tanzania.

OBJECTIVE: This is an extended analysis of the previously published data to demonstrate the relationship between high Obstetric Care Facility Density (OCFD) and migration for obstetric services in Tanzania. RESULTS: Overall, regions with excess institutional deliveries had significantly higher OCFD compared to other regions. A consistent pattern was observed whereby regions with excess Institutional deliveries also exhibited the most outstanding OCFD of all the neighbouring regions. The observed patterns of Institutional deliveries and OCFD affirm the hypothesis of immigration for obstetric care services from low to high OCFD regions. Further research is suggested to prove this hypothesis in the field.

Sexual behavior and condom use among male students in Dar-Es-Salaam, Tanzania with emphasis on contact with barmaids.

OBJECTIVE: The objective of this quantitative study was to identifying factors that influence young men to participate in risky sexual behavior that place them at risk of HIV infection, as young people are at higher risk for HIV infection than adults. METHODS: A cross-sectional study design that employed face-to-face interview questionnaire to identify socio-demographic characteristics, sexual behavior, knowledge of HIV, STD, attitudes towards condoms was administered to 175 sexually active male students between 17 and 24 years old in college settings of Dar-es-Salaam city, Tanzania. RESULTS: In the previous 12 months, 80% of students had at least one steady sex partner (girlfriend), 71% had sex with a barmaid, 33% had sex with a casual partner and 83% had multiple sex partners. Condoms had been used at some time by 83% of students, and in the latest sexual encounter by 56%. However, only 37%, 22%, and 11% consistently used condoms during sex with girlfriends, casual partners and barmaids, respectively. Condom use was least popular during sex with barmaids, and 94% and 91% of students had experienced oral and anal sex with barmaids, respectively. STD infection was reported by 42% of students. Sex with barmaids was associated with alcohol and illicit drug intake, sex under their respective influences, and STD infection. Despite the high prevalence of these risky behaviors, 64% of students replied that they were at low or no risk of HIV infection. CONCLUSION: Our findings suggest that HIV prevention programs for male students should emphasize risks associated with multiple sexual partners, and sex with barmaids and casual partners, to increase the risk perception of HIV/AIDS. Condom use needs to be promoted.

Attitudes and beliefs about HIV/AIDS behaviour and education among Tanzanian youth.

BACKGROUND: Tanzania faced with an increasing problem from HIV sexual infection and vulnerability of students is a key concern. This paper explores beliefs, attitudes and behavioural perspectives on HIV/AIDS education among students in Tanzania as there has been few qualitative information on the subject. METHODS: A total of 20 college students of both sexes were interviewed in a qualitative study. Health Belief Model and Social Cognitive Theory were used to guide the interview and constant comparative analysis on their attitudes, beliefs, behaviour and education towards HIV infection risks were utilised. RESULTS: During the interview, the following topics emerged: misinformation and desire for HIV/AIDS education program in school curricula; perceptions of one's own and peer's susceptibility to HIV infection; social norms regarding sexual behaviour and perceptions regarding access to education and health services. Lack of accurate information and lack of education at home and at school further contributed to risk behaviour. CONCLUSION: The study highlighted important perspectives of students towards HIV infection, risk behaviours which are important for HIV prevention programs for students. Based on the findings, recommendations for improvement in prevention programs among college students within Tanzanian schools context are discussed.

Services and attitudes to people living with HIV/AIDS among college students in Dar-es-Salaam, Tanzania.

OBJECTIVES: The objective of this study was to evaluate acceptability of voluntary testing, counselling and treatment services and attitudes towards people living with HIV/AIDS from young people's point of view. METHODS: Qualitative study (face-to-face interviews in which tapes were used) were carried out in 20 interviewed college students aged between 19-24 years of both sexes based in Dar-es-Salaam, Tanzania. RESULTS: Results showed that voluntary counselling and testing services were limited in the study area at the time of study. Participants complained of unfriendly services and unco-operative staff, poor counselling services and shortage of facilities and staff. There was fear of HIV/AIDS related stigma toward people living with HIV and AIDS, thus fostering stigma and isolation against them. Results further demonstrate that HIV/AIDS related stigma is still a very serious problem in Tanzania. Lack of HIV/AIDS related knowledge and the life-threatening character of the disease were seen as the most important determinants of AIDS-related stigma. The main benefit to go for VCT was 'knowing your status before marriage', whereas main barriers for testing were 'fear of being stigmatised' and 'fear of knowing your HIV positive status'. CONCLUSION: The results suggest that there is need of VCT specific intervention programs for young people in colleges in Tanzania to emphasize of importance of VCT services and HIV/AIDS education program to educate students' understanding of people living with HIV/AIDS, thus reducing stigma towards people living with HIV/AIDS.