Perinatal loss in Tanzania: Perspectives of maternal-child healthcare providers.

Over 98% of stillbirths and neonatal deaths occur in Low- and Middle-Income Countries, such as Tanzania. Despite the profound burden of perinatal loss in these regions, access to facility or community-based palliative and psychosocial care is poor and understudied. In this study we explore perinatal loss through the lens of front-line healthcare providers, to better understand the knowledge and beliefs that guide their engagement with bereaved families. A Knowledge Attitudes and Practices survey addressing perinatal loss in Tanzania was developed, translated into Swahili, and administered over a 4-month period to healthcare professionals working at the Kilimanjaro Christian Medical Center (KCMC). Results were entered into REDCap and analyzed in R Studio. 74 providers completed the survey. Pediatric providers saw a yearly average of 5 stillbirths and 32.7 neonatal deaths. Obstetric providers saw an average of 11.5 stillbirths and 13.12 neonatal deaths. Most providers would provide resuscitation beginning at 28 weeks gestational age. Respondents estimated that a 50% chance of survival for a newborn occurred at 28 weeks both nationally and at KCMC. Most providers felt that stillbirth and neonatal mortality were not the mother's fault (78.4% and 81.1%). However, nearly half (44.6%) felt that stillbirth reflects negatively on the woman and 62.2% agreed that women are at higher risk of abuse or abandonment after stillbirth. A majority perceived that women wanted hold their child after stillbirth (63.0%) or neonatal death (70.3%). Overall, this study found that providers at KCMC perceived that women are at greater risk of psychosocial or physical harm following perinatal loss. How women can best be supported by both the health system and their community remains unclear. More research on perinatal loss and bereavement in LMICs is needed to inform patient-level and health-systems interventions addressing care gaps unique to resource-limited or non-western settings.

Infection Prevention Performance among Hospital Staff during Vaginal Birth: Results from a Criterion-Based Audit at a Zonal Referral Hospital in Tanzania.

BACKGROUND: Healthcare associated infections is a global burden and is one of the main causes of maternal and neonatal morbidity and mortality during the time of labour when admitted to the hospital. Healthcare workers' hands are in most cases the vehicle for transmission of microorganisms from patient to patient. Good hand hygiene practices at the bedside are a simple way of reducing healthcare associated infections. The objective was to assess the impact of a criterion-based audit on infection prevention performance and knowledge during vaginal delivery at a hospital in Tanzania. The quantitative findings were discussed with staff to identify barriers and solutions to quality improvement. METHODS: A mixed-method uncontrolled, before and after intervention study by criterion-based audit was performed at the labour ward at Kilimanjaro Christian Medical Centre. Criteria for best practice were established together with key staff based on national and international guidelines. Sixty clean procedures during vaginal birth were observed and assessed by a structured checklist based on the audit criteria. Baseline findings were discussed with staff and an intervention performed including a short training and preparation of alcohol-based hand rub. Hereafter another 60 clean procedures were observed, and performance compared to the care before the intervention. Furthermore, a knowledge test was performed before and after the intervention. RESULTS: Hand washing increased significantly after a procedure from 46.7% to 80% (RR=1.71 95% CI; 1.27 to 2.31), the use of alcohol-based hand rub before a procedure from 1.7% to 33.3% p<.001), and the use of alcohol-based hand rub after procedure from 0% to 30% p<.00l). After the intervention the mean score for the knowledge test increased insignificantly from 59.3% to 65.3%, (mean difference = 6.1%, 95% CI; -4.69 to 16.88). CONCLUSION: The criterion-based audit process identified substandard care for infection prevention at the labour ward. An intervention of discussing baseline findings and a short training session and introducing alcohol-based hand rub resulted in improvements on infection prevention performance.

Criterion-Based Audit of Hand Hygiene Performance During Caesarean Section at a Referral Hospital in Northern Tanzania: An Uncontrolled Interventional Study.

BACKGROUND: Health-care-associated infection (HCAI) is a big challenge in both low- and high-income countries. Around childbirth, infection is among the main causes of maternal and perinatal morbidity and mortality. Appropriate hand hygiene practice is a simple and cost-effective way of reducing HCAIs. This study aimed to assess the baseline performance and knowledge of proper hand hygiene during caesarean sections and the impact of interventions guided by a criterion-based audit at a tertiary health facility in Tanzania. METHODS: A noncontrolled, before-and-after intervention study, guided by a criterion-based audit, was carried out. A criterion based checklist was used for direct observations of hand hygiene performance during cesarean section. A self-administered questionnaire was used to assess knowledge on infection prevention. Performance was compared before and after a half-way intervention. RESULTS: At baseline, low-quality hand hygiene performance was observed. Significant improvements of hand hygiene performance were observed for a number of criteria. Long nails: performance reduction from 15 (25%) to 3 (5%) (P=.04), polished nails: from 11 (18%) to 1 (2%) (P=.04), a score increase in hand wash with water from 43.8 (73%) to 60 (100%) (P=.001). Postoperatively, correct glove removal increased from 20 (33%) to 37.8 (66%) (P=.01). Alcohol-based hand rub use increased from 2 (3%) to 21 (35%) (P=.001). The number of health-care workers who did not wash hands after procedure with either water or alcohol-based hand rub reduced from 35 (58%) to 10 (17%) (P=.001). After the intervention, poor knowledge among health-care workers reduced from 7 (39%) to 3 (17%), while moderate knowledge increased from 8 (44%) to 12 (67%). CONCLUSION: Feedback, discussion of findings, training, visual reminders, and distribution of alcohol-based hand rub, as part of a criterion-based audit is a powerful way of improving hand hygiene performance and knowledge in surgical wards.