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Mwakawanga DL, Rimoy M, Mwanga F, Massae AF, Mushy SE, Kisaka L, Komba N, Mabada L, Mlay E, Mwakalinga E, Mwasha L, Temba FF, Sirili N. Strengthening midwives' competencies for addressing maternal and newborn mortality in Tanzania: Lessons from Midwifery Emergency Skills Training (MEST) project. Midwifery 2023; 122:103695. [PMID: 37119672 DOI: 10.1016/j.midw.2023.103695] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2022] [Revised: 04/06/2023] [Accepted: 04/11/2023] [Indexed: 05/01/2023]
Abstract
INTRODUCTION In Low- and Middle-Income Countries (LMICs), maternal and infant mortality remains a significant problem. Inadequate healthcare provider competencies, including those of midwives, are cited as one of the major contributors to the high maternal and newborn mortality rates. Thus, enhancing the skills of midwives is a prerequisite for enhancing positive maternal and newborn health outcomes. This study describes the lessons learned from a Midwifery Emergencies Skills Training (MEST) project implemented in Tanzania between 2013 and 2018. METHODS An exploratory qualitative study was used to purposefully recruit and interview twelve health facility in-charges and eighteen midwives from twelve selected health facilities in six districts of Tanzania mainland to discover their perceptions about the midwifery practice after MEST training. The data were transcribed verbatim and analysed with qualitative content analysis. RESULTS Four categories were generated from the analysis (i) enhanced knowledge and skills in the provision of midwifery care and management of obstetric emergencies, (ii) improved midwives' communication skills, (iii) increased trust and support between midwives and community and (iv) transformed attitudes of midwives toward continued professional development (CPD). CONCLUSION MEST enhanced the knowledge and skills of midwives in the management of obstetric emergencies and referral protocol practice. However, notable gaps remain in the capacity of midwives to provide human rights-based respectful maternity care. Continued professional development for nurses and midwives through training, mentorship and supervision programs is recommended for improving maternal and newborn health.
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Affiliation(s)
- Dorkasi L Mwakawanga
- School of Nursing, Muhimbili University of Health and Allied Sciences, P.O Box 65001 Dar es Salaam, Tanzania.
| | - Martha Rimoy
- Tanzania Midwives Association, P.O Box 65524 Dar es Salaam, Tanzania
| | - Feddy Mwanga
- Tanzania Midwives Association, P.O Box 65524 Dar es Salaam, Tanzania
| | - Agnes F Massae
- School of Nursing, Muhimbili University of Health and Allied Sciences, P.O Box 65001 Dar es Salaam, Tanzania
| | - Stella E Mushy
- School of Nursing, Muhimbili University of Health and Allied Sciences, P.O Box 65001 Dar es Salaam, Tanzania
| | - Lucy Kisaka
- The Aga Khan University, School of Nursing and Midwifery, P.O Box 38129 Dar es Salaam, Tanzania
| | - Nicodem Komba
- Tanzania Midwives Association, P.O Box 65524 Dar es Salaam, Tanzania; Muhimbili National Hospital, P.O Box 65000 Dar es Salaam, Tanzania
| | - Lucy Mabada
- Tanzania Midwives Association, P.O Box 65524 Dar es Salaam, Tanzania
| | - Ecstasy Mlay
- Muhimbili National Hospital, P.O Box 65000 Dar es Salaam, Tanzania
| | | | - Loveluck Mwasha
- Tanzania Midwives Association, P.O Box 65524 Dar es Salaam, Tanzania; The Aga Khan University, School of Nursing and Midwifery, P.O Box 38129 Dar es Salaam, Tanzania
| | | | - Nathanael Sirili
- School of Public Health and Social Sciences, Muhimbili University of Health and Allied Sciences, P.O Box 65013, Dar es Salaam, Tanzania
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Baynes C, Kahwa J, Lusiola G, Mwanga F, Bantambya J, Ngosso L, Hiza M. What contraception do women use after experiencing complications from abortion? an analysis of cohort records of 18,688 postabortion care clients in Tanzania. BMC Womens Health 2019; 19:22. [PMID: 30691443 PMCID: PMC6350325 DOI: 10.1186/s12905-018-0687-9] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/06/2017] [Accepted: 11/21/2018] [Indexed: 11/10/2022]
Abstract
Background The family planning component of postabortion care (PAC) is critical, as it helps women to prevent unintended pregnancies and reduce future incidence of life-threatening unsafe abortion. In Tanzania, PAC was recently decentralized from tertiary-level district hospitals to primary health care dispensaries in four regions of the country. This analysis describes interventions used to improve access to high quality PAC services during decentralization; examines results and factors that contribute to PAC clients’ voluntary uptake of contraception; and develops recommendations for improving postabortion contraceptive services. Methods This analysis uses service delivery statistics of 18,688 PAC clients compiled from 120 facilities in Tanzania between 2005 and 2014. Results This study suggests that efforts to integrate postabortion family planning into treatment for incomplete abortion contributed to higher postabortion contraceptive uptake (86%). Results indicate that variables associated with significant differences in contraceptive uptake were facility level, age, gestational age at the time of treatment, and uterine evacuation technology used. Conclusion The experience of expanding PAC services in Tanzania suggests that integrating contraceptive services with treatment for abortion complications can increase family planning use.
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Affiliation(s)
- Colin Baynes
- EngenderHealth, 440 Ninth Avenue, New York City, NY, 10001, United States.
| | - J Kahwa
- EngenderHealth, Plot #254, Mwai Kibaki Road/Kiko Avenue, PO Box 78167, Dar es Salaam, Tanzania
| | - G Lusiola
- EngenderHealth, Plot #254, Mwai Kibaki Road/Kiko Avenue, PO Box 78167, Dar es Salaam, Tanzania
| | - F Mwanga
- EngenderHealth, Plot #254, Mwai Kibaki Road/Kiko Avenue, PO Box 78167, Dar es Salaam, Tanzania
| | - J Bantambya
- EngenderHealth, Plot #254, Mwai Kibaki Road/Kiko Avenue, PO Box 78167, Dar es Salaam, Tanzania
| | - L Ngosso
- EngenderHealth, Plot #254, Mwai Kibaki Road/Kiko Avenue, PO Box 78167, Dar es Salaam, Tanzania
| | - M Hiza
- Ministry of Health, Community Development, Gender, Elderly and Children (MOHCDGEC), PO Box 9083, Dar es Salaam, Tanzania
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Sandwell R, Bonser D, Hebert E, Kilroy K, Leshabari S, Mwanga F, Mtawa A, Wilson A, Moritz A. Stronger together: midwifery twinning between Tanzania and Canada. Global Health 2018; 14:123. [PMID: 30545394 PMCID: PMC6293498 DOI: 10.1186/s12992-018-0442-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2018] [Accepted: 11/20/2018] [Indexed: 11/10/2022] Open
Abstract
This article describes a twinning relationship between the Canadian Association of Midwives (CAM) and the Tanzania Midwives Association (TAMA). It argues that the twinning relationship strengthened both associations. The article briefly reviews the existing literature on professional associations and association strengthening to demonstrate that professional associations are a vital tool for improving the performance of healthcare workers and increasing their capacity to contribute to national and international policy-making. It then suggests that midwifery associations are particularly significant given the frequent professional marginalization of midwives. The article then describes in depth the relationship between CAM and TAMA, highlighting the accomplishments of the twinned partners, and analyzing the factors that contributed to the success of the relationship. The findings demonstrate that twinning can successfully strengthen associations, increasing their ability to support their membership, care for the public, and shape national policy-making. The article therefore proposes twinning as a successful and cost-effective model for encouraging the growth of the midwifery profession.
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Affiliation(s)
- Rachel Sandwell
- Canadian Association of Midwives, 2330 rue Notre Dame, Suite 300, Montreal, QC, H3J 1N4, Canada.
| | - Deborah Bonser
- Canadian Association of Midwives, 2330 rue Notre Dame, Suite 300, Montreal, QC, H3J 1N4, Canada
| | - Emmanuelle Hebert
- Canadian Association of Midwives, 2330 rue Notre Dame, Suite 300, Montreal, QC, H3J 1N4, Canada
| | - Katrina Kilroy
- Midwives Collective of Toronto, 1203 Bloor St West, Toronto, ON, M6N 1H4, Canada
| | - Sebalda Leshabari
- School of Nursing, Muhimbili University of Health and Allied Sciences, P. O. Box 65169, Dar es Salaam, Tanzania
| | - Feddy Mwanga
- Tanzania Midwives Association, P.O. Box 65524, Dar Es Salaam, Tanzania
| | - Agnes Mtawa
- Tanzania Nursing and Midwifery Council, Kaluta Street, P. O. Box 6632, Dar es Salaam, Tanzania
| | - Anne Wilson
- Canadian Association of Midwives, 2330 rue Notre Dame, Suite 300, Montreal, QC, H3J 1N4, Canada
| | - Amelie Moritz
- Fondation Sanofi Espoir, 262, Boulevard Saint Germain, 75007, PARIS, France
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Muganyizi PS, Ishengoma J, Kanama J, Kikumbih N, Mwanga F, Killian R, McGinn E. An analysis of pre-service family planning teaching in clinical and nursing education in Tanzania. BMC Med Educ 2014; 14:142. [PMID: 25016391 PMCID: PMC4108963 DOI: 10.1186/1472-6920-14-142] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/25/2013] [Accepted: 06/30/2014] [Indexed: 06/03/2023]
Abstract
BACKGROUND Promoting family planning (FP) is a key strategy for health, economic and population growth. Sub-Saharan Africa, with one of the lowest contraceptive prevalence and highest fertility rates globally, contributes half of the global maternal deaths. Improving the quality of FP services, including enhancing pre-service FP teaching, has the potential to improve contraceptive prevalence. In efforts to improve the quality of FP services in Tanzania, including provider skills, this study sought to identify gaps in pre-service FP teaching and suggest opportunities for strengthening the training. METHODS Data were collected from all medical schools and a representative sample of pre-service nursing, Assistant Medical Officer (AMO), Clinical Officer (CO) and assistant CO schools in mainland Tanzania. Teachers responsible for FP teaching at the schools were interviewed using a semi-structured questionnaire. Observations on availability of teaching resources and other evidence of FP teaching and evaluation were documented. Relevant approved teaching documents were assessed for their suitability as competency-based FP teaching tools against predefined criteria. Quantitative data were analyzed using EPI Info 6 and qualitative data were manually analyzed using content analysis. RESULTS A total of 35 pre-service schools were evaluated for FP teaching including 30 technical education and five degree offering schools. Of the assessed 11 pre-service curricula, only one met the criteria for suitability of FP teaching. FP teaching was typically theoretical with only 22.9% of all the schools having systems in place to produce graduates who could skillfully provide FP methods. Across schools, the target skills were the same level of competence and skewed toward short acting methods of contraception. Only 23.3% (n = 7) of schools had skills laboratories, 76% (n = 22) were either physically connected or linked to FP clinics. None of the degree providing schools practiced FP at its own teaching hospital. Teachers were concerned with poor practical exposure and lack of teaching material. CONCLUSIONS Pre-service FP teaching in Tanzania is theoretical, poorly guided, and skewed toward short acting methods; a majority of the schools are unable to produce competent FP service providers. Pre-service FP training should be strengthened with more focus on practical skills.
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Affiliation(s)
- Projestine S Muganyizi
- Department of Obstetrics & Gynecology, Muhimbili University of Health Sciences (MUHAS), P.O. Box 65117, Dar es Salaam, Tanzania
| | - Joyce Ishengoma
- Engender Health, ACQUIRE Tanzania Project (ATP), P.O. Box 78176, Dar es Salaam, Tanzania
| | - Joseph Kanama
- Engender Health, ACQUIRE Tanzania Project (ATP), P.O. Box 78176, Dar es Salaam, Tanzania
| | - Nassoro Kikumbih
- Engender Health, ACQUIRE Tanzania Project (ATP), P.O. Box 78176, Dar es Salaam, Tanzania
| | - Feddy Mwanga
- Engender Health, ACQUIRE Tanzania Project (ATP), P.O. Box 78176, Dar es Salaam, Tanzania
| | - Richard Killian
- Engender Health, ACQUIRE Tanzania Project (ATP), P.O. Box 78176, Dar es Salaam, Tanzania
| | - Erin McGinn
- Engender Health 440 Ninth Avenue, New York, NY 100001, USA
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Abrahams N, Adhikari R, Bhagwat IP, Christofides N, Djibuti M, Dyalchand A, Gotsadze G, Grzmava O, Huertas LLR, Jacobs T, Jewkes R, Kapadia-Kundu N, Karnikowski MGO, Kimboka S, Kitua AY, Lens JU, López A, Lugina H, Mashalla Y, Mishra A, Mishra SK, Mlay R, Moreno MJ, Mpanda S, Mwanga F, Ndossi G, Nigenda G, Nkwera A, Nóbrega OT, Pahari SK, Paz SA, Phoolchareon W, Ramachandran P, Rannan-Eliya RP, Rodrigues KG, Salazar A, Sarma PS, Shija J, Silver LD, Tatsanavivat P, Thankappan KR, Tuesta AJA, Vasadze O, Vélez ACG, Webster N, Yesudian CAK. Changing the debate about health research for development. International Health Research Awards Recipients. J Public Health Policy 2005; 25:259-87. [PMID: 15683065 DOI: 10.1057/palgrave.jphp.3190028] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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