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Fear of childbirth (FoB) and depressive symptoms (DS) are experienced by many women and can negatively affect women during and after pregnancy. This study assessed patterns of FoB and DS over time and associations of postpartum FoB and DS with sociodemographic and obstetric characteristics. We conducted a longitudinal study at six health facilities in Tanzania in 2018-2019. Pregnant women were consecutively assessed for FoB and DS before and after childbirth using the Wijma Delivery Expectancy/Experience Questionnaire versions A & B and the Edinburgh antenatal and postnatal depressive scale. This paper is based on 625 women who completed participation. The prevalence rates of FoB and DS during pregnancy were 16% and 18.2%, respectively, and after childbirth, 13.9% and 8.5%. Some had FoB (6.4%) and DS (4.3%) at both timepoints. FoB was strongly associated with DS at both timepoints (p < 0.001). Both FoB (p = 0.246) and DS (p < 0.001) decreased after childbirth. Never having experienced obstetric complications decreased the odds of postpartum and persisting FoB (adjusted odds ratio (aOR) 0.44, 95% confidence interval (CI) 0.23-0.83). Giving birth by caesarean section (aOR 2.01, 95% CI 1.11-3.65) and having more than 12 hours pass between admission and childbirth increased the odds of postpartum FoB (aOR 2.07, 95% CI 1.03-4.16). Postpartum DS was more common in women with an ill child/stillbirth/early neonatal death (aOR 4.78, 95% CI 2.29-9.95). Persisting DS was more common in single (aOR 2.59, 95% CI 1.02-6.59) and women without social support from parents (aOR 0.28, 95% 0.11-0.69). FoB and DS coexist and decrease over time. Identifying predictors of both conditions will aid in recognising women at risk and planning for prevention and treatment. Screening for FoB and DS before and after childbirth and offering psychological support should be considered part of routine antenatal and postnatal care. Furthermore, supporting women with previous obstetric complications is crucial. Using interviews instead of a self-administered approach might have contributed to social desirability. Also, excluding women with previous caesarean sections could underestimate FoB and DS prevalence rates.

To understand why caesarean sections are performed for stillborn babies by investigating caesarean section rates and indications in sub-Saharan African countries and to examine whether fetal vital status at admission is associated with caesarean section. The study involved registry data on 105 872 babies weighing 1000 g or more born to women aged 13 to 50 years at 16 hospitals in Benin, Malawi, Uganda and United Republic of Tanzania between 1 July 2021 and 30 June 2023. We assessed caesarean section rates and indications, and used multivariable logistic regression analyses to estimate associations between fetal heartbeat at admission and caesarean section, by birth outcome. The caesarean section rate was 28.0% (29 640/105 872) overall, 40.9% (858/2098) for intrapartum stillbirths and 19.0% (322/1694) for antepartum stillbirths. Previous caesarean section was among the top three indications across birth outcomes. Information on fetal heartbeat at admission was unavailable for 24.7% (7312/29 640) of caesarean section births. Multivariable analysis showed that the odds of a caesarean section was significantly higher when fetal heartbeat was not reported compared with the detection of a heartbeat among both antepartum (adjusted odds ratio, aOR: 2.55; 95% confidence interval, CI: 1.53-4.26) and intrapartum (aOR: 2.08; 95% CI: 1.51-2.87) stillbirths. Unknown fetal heartbeat at admission was associated with a higher odds of caesarean section, possibly due to attempts to provide optimum care given diagnostic uncertainty. Decision-making processes on the mode of birth need to be better understood and feasible fetal monitoring recommendations are required for low-resource settings.

We aimed to determine the prevalence and factors associated with the use of long-acting reversible contraceptives (LARCs) among women of reproductive age in Tanzania. We analyzed the Tanzania Demographic and Health Survey (DHS) data from 2015 to 2016. The study included 8189 women aged 15–49 years. The relationship between various factors and LARC use was determined through various analyses. Among women with a partner/husband, 7.27% used LARCs, 21.07% were grand multiparous, and 20.56% did not desire more children. Women aged 36–49 years (adjusted odds ratio (AOR)-2.10, 95% confidence interval (CI): 1.11–3.96), who completed secondary education (AOR-1.64, 95% CI: 1.05–2.55), who did not desire more children (AOR-2.28, 95% CI: 1.53–3.41), with a partner with primary level education (AOR-2.02, 95% CI: 1.34–3.02), or living in richer households (AOR-1.60, 95% CI: 1.12–2.27) were more likely to use LARCs. Further, women with a partner who wanted more children were less likely to use LARCs (AOR-0.69, 95% CI: 0.54–0.90). Tanzania has a low LARC usage rate. Women’s age, wife and partner’s education status, couple’s desire for more children, and household wealth index influenced the use of LARCs, highlighting the need to reach more couples of lower socioeconomic status to improve LARC utilization.

Our study aimed to assess the effect of Helping Mothers Survive Bleeding after Birth on knowledge and skills of health workers and whether such effect varies by health workers characteristics. Nested in a cluster-randomised trial to assess the effect of the training on health outcomes, we assessed changes in knowledge and simulated skills in 61 facilities. The assessments were done i) before, ii) immediately-after training session and iii) at 10-month follow-up for subset of health-workers of implementation facilities as defined by the trial. We used a self-administered questionnaire and Objective Structures Clinical Examinations to assess three skill sets: Active Management of Third Stage of Labour, removal of retained placenta and management of severe postpartum haemorrhage. We computed summary statistics and used the paired t-test to assess change of knowledge and skills immediately post-training and at 10-month follow-up. Linear regression was done to assess association of scores and health worker characteristics. Of the 636 health workers included, 606 (96.7%) and 591 (91.4%) completed the knowledge and skills assessments, respectively. Majority of the participants (68%) were nurse-midwives. Knowledge scores increased by 15 percentage-points from 77.5% to 93% (95% CI 14.3, 16.3, p-value <0.000), and skills scores by 47 percentage-points (95% CI 46.5, 49.2, p-value <0.000) from 37.5% to 83%. There was a 4.0% decline of skills at 10-month follow-up. The decline was higher in auxiliary staff (-11.8%) and least in nurse-midwives (-2.1%) p-value <0.001. Health workers who assisted less than 5 deliveries in the last month, those who never attended postpartum haemorrhage in-service training and profession experience >8 years were associated with lower mean skill change immediately post-training. Our study supports the potential of the Helping Mothers Survive Bleeding after Birth training to increase knowledge and skills of postpartum haemorrhage among all professional groups. Auxiliary staff benefited most from the training but also showed higher skill decline at 10-month. Our study highlights the importance to disaggregate knowledge and skills by health workers characteristics.

Background Many women experience fear of childbirth (FoB) and depressive symptoms (DS) during pregnancy, but little is known about FoB among Tanzanian women. The current study aimed to assess the prevalence of FoB and DS among pregnant women and determine predictors of each and both, focusing on sociodemographic and obstetric predictors. Methods A cross-sectional study was conducted at six health facilities in two districts in Tanzania between 2018 and 2019. In total, 694 pregnant women with gestational age between 32 and 40 weeks and expecting vaginal delivery were consecutively recruited and assessed for FoB and DS. We collected data through interviews using 6 and 4-points Likert Scale of the Wijma Delivery Expectancy Questionnaire Version A and Edinburgh Postnatal Depression Scale, respectively. Women who scored ≥66 and ≥ 10 were categorised as having FoB and DS, respectively. We performed multivariable logistic regression to investigate the predictors of FoB and DS. Results The prevalence rates of FoB and DS among pregnant women were 15.1 and 17.7%, respectively. FoB and DS were more likely in women aged above 30 years [Adjusted Odds Ratio (AOR) 6.29, 95%CI 1.43–27.84] and in single mothers (AOR 2.57, 95%CI 1.14–5.78). Women with secondary education and above (AOR 0.22, 95%CI 0.05–0.99) and those who had given birth previously (AOR 0.27, 95% CI 0.09–0.87) were less likely to have FoB in combination with DS Women who had previous obstetric complications, and those who did not receive any social support from male partners in previous childbirth were more likely to have FoB and DS. FoB was strongly associated with DS (AOR 3.42, 95%CI 2.12–5.53). DS only was more common in women who had inadequate income (AOR 2.35, 95%CI 1.38–3.99) or had previously experienced a perineal tear (AOR 2.32, 95%CI 1.31–4.08). Conclusions Not having a formal education, having only primary education, being aged above 30 years, being single, being nulliparous, having experienced obstetric complications, and having a lack of social support from a male partner during previous pregnancy and childbirth were predictors of FoB and DS during pregnancy. FoB and DS were strongly associated with each other. It is vital to identify at-risk women early, to offer support during pregnancy and childbirth.

in Tanzania, for the past decade, there has been a rising trend of women with short inter-pregnancy interval (IPI) (16% to 19%). Short IPI is associated with poor maternal and neonatal outcomes. We aimed to determine the factors associated with short IPI among women attending antenatal clinic (ANC) at Mnazi Mmoja Hospital, Dar es Salaam, Tanzania. a cross-sectional study was conducted in September 2018 at Mnazi Mmoja hospital among women receiving ante-natal care. A total of 530 women were included in the analysis. Analysis was conducted through SPSS version 24 computer program using descriptive analyses to determine the IPI and characteristics thereof, and logistic regression analysis to examine factors associated with IPI among pregnant women. Associations with a p-value < 0.05 were considered statistically significant. twenty-two percent of the women attending ANC in Mnazi Mmoja hospital had short IPI. Short IPI was associated with young (<25years) age (AOR=2.67, 95% CI=1.23-5.79); non-use of a contraceptive method (AOR=2.05, 95%CI=1.22-3.45); breastfeeding for less than 6 months (AOR=3.45, 95% CI=1.17-10.13) and having an antecedent dead child at the time of index conception (AOR=3.38, 95% CI=1.15-9.93). about 1 in every 5 women attending ANC in Dar es Salaam had a short IPI. Addressing short IPI will complement the government´s efforts to improve maternal indicators in Tanzania and areas with similar contexts. Such efforts should emphasize in adherence to recommended infant feeding practices, women at a younger reproductive age group, those with a history of pregnancy loss, and strengthening contraception use among women of reproductive age.

IntroductionIn sub-Saharan Africa, referral hospitals are important sources of key maternal health services, especially during a crisis such as the COVID-19 pandemic. This study prospectively assessed the effect of the COVID-19 pandemic on maternal health service utilisation in six large referral hospitals in Guinea, Nigeria, Tanzania and Uganda during the first year of the pandemic.MethodsMixed-methods design combining three data sources: (1) quantitative data based on routine antenatal, childbirth and postnatal care data collected March 2019–February 2021, (2) qualitative data from recurring rounds of semi-structured interviews conducted July 2020–February 2021 with 22 maternity skilled heath personnel exploring their perceptions of service utilisation and (3) timeline data of COVID-19 epidemiology, global, national and hospital-level events. Qualitative and quantitative data were analysed separately, framed based on the timeline analysis and triangulated when reporting.ResultsThree periods including a first wave, slow period and second wave were identified. Maternal health service utilisation was lower during the pandemic compared with the prepandemic year in all but one selected referral hospital. During the pandemic, service utilisation was particularly lower during the waves and higher or stable during the slow period. Fear of being infected in hospitals, lack of transportation, and even when available, high cost of transportation and service closures were key reasons affecting utilisation during the waves. However, community perception that the pandemic was over or insinuation by Government of the same appeared to stabilise use of referral hospitals for childbirth.ConclusionUtilisation of maternal health services across the continuum of care varied through the different periods and across countries. In crisis situations such as COVID-19, restrictions and service closures need to be implemented with consideration given to alternative options for women to access and use services. Information on measures put in place for safe hospital use should be communicated to women.

ObjectivesThis study aimed to explore experiences of communication as an element of quality of care, among women surviving a maternal near-miss event, thus women who nearly died but survived haemorrhage, or pre-eclampsia complication during pregnancy, childbirth or within 42 days of termination of pregnancy.DesignA descriptive, phenomenological, qualitative study using semistructured interviews with women who survived a maternal near-miss in Southern Tanzania.SettingThe participants were recruited from two selected hospitals in Mtwara Region, where women sought child birth care and developed near-miss condition.ParticipantsParticipants for this study were women who experienced and survived a maternal near-miss event and who had lived in the study area for at least 1 year. Women were recruited using an adapted version of the WHO criteria for maternal near-miss.Data collectionWe identified 16 women and were able to conduct 10 in-depth interviews with women at their homes, 4 weeks after they were discharged. The interviews were audiorecorded and transcribed and translated word for word from Kiswahili. Thematic analysis was used to identify emerging themes.ResultsThree major themes evolved: (1) Being informed about the care and interaction, (2) Being engaged and encouraged and (3) Being afraid to ask questions. The study highlighted that good communication with women during the provision of care helped women feel grateful, supported and cared for. Women who were unconscious during care were often not informed later of what happened. This created some negative feelings and anxiety.ConclusionThis study highlights the importance of communication, and of being informed of what happened and why. Empathetic communication with sufficient explanation on what happened and why created trust among women—a positive finding which should encourage the development of consistent approaches to strengthen healthcare provider communication skills.

IntroductionDigital data systems have the potential to improve data quality and provide individual-level information to understand gaps in the quality of care. This study explored experiences and perceptions of a perinatal eRegistry in two hospitals in Mtwara region, Tanzania. Drawing from realist evaluation and systems thinking, we go beyond a descriptive account of stakeholders’ experiences and provide insight into key structural drivers and underlying social paradigms.MethodsWe carried out 6 weeks of focused ethnographic observations at the labour wards of the two hospitals and 29 semi-structured qualitative interviews with labour ward staff, as well as with administrative and managerial stakeholders at hospital, district and regional levels. Multi-stage reflexive thematic data analysis was carried out.ResultsWe provide an in-depth account of the day-to-day functioning of the eRegistry in the two hospitals, including both aspects of positive change and key challenges with its integration into routine documentation duties. Experiences with and perceptions of the eRegistry were inextricably linked to broader systemic constraints relating to staffing, workload and infrastructure. A key underlying theme shaping the way people engaged with the eRegistry was the notion of data ownership: the presence or absence of a feeling of being responsible, involved and in control of data.ConclusionSome of the key systemic challenges in recording accurate, timely information about women and their babies are not solved by digital tools. Our findings also underline that when healthcare workers feel that data are not primarily for them, they document only for reporting purposes. The eRegistry increased a sense of data ownership among the nurse-midwives directly involved with data entry, but the potential for promoting and supporting data use feedback loops for improvement in care provision remained largely untapped. Our findings highlight the importance of local relevance and ownership in digitisation of routine health information systems.

ObjectivesThe COVID-19 pandemic affected provision and use of maternal health services. This study describes changes in obstetric complications, referrals, stillbirths and maternal deaths during the first year of the pandemic and elucidates pathways to these changes.DesignProspective observational mixed-methods study, combining monthly routine data (March 2019–February 2021) and qualitative data from prospective semi-structured interviews. Data were analysed separately, triangulated during synthesis and presented along three country-specific pandemic periods: first wave, slow period and second wave.SettingSix referral maternities in four sub-Saharan African countries: Guinea, Nigeria, Tanzania and Uganda.Participants22 skilled health personnel (SHP) working in the maternity wards of various cadres and seniority levels.ResultsPercentages of obstetric complications were constant in four of the six hospitals. The percentage of obstetric referrals received was stable in Guinea and increased at various times in other hospitals. SHP reported unpredictability in the number of referrals due to changing referral networks. All six hospitals registered a slight increase in stillbirths during the study period, the highest increase (by 30%–40%) was observed in Uganda. Four hospitals registered increases in facility maternal mortality ratio; the highest increase was in Guinea (by 158%), which had a relatively mild COVID-19 epidemic. These increases were not due to mortality among women with COVID-19. The main pathways leading to these trends were delayed care utilisation and disruptions in accessing care, including sub-optimal referral linkages and health service closures.ConclusionsMaternal and perinatal survival was negatively affected in referral hospitals in sub-Saharan Africa during COVID-19. Routine data systems in referral hospitals must be fully used as they hold potential in informing adaptations of maternal care services. If combined with information on women’s and care providers’ needs, this can contribute to ensuring continuation of essential care provision during emergency.