Maternal Health: Delivery and Newborn Care 2014-15 Tanzania Service Provision Assessment (TSPA)
Background of Delivery Care Services Availability of Services Service Readiness Management Practices and Training Signal Functions for Emergency Obstetric Care Newborn Care Practices 2014 Megan Ivankovich/WI-HER LLC, Courtesy of Photoshare
Percent distribution of live births in the 5 years before the survey Place of Delivery (2010 TDHS) Total Mainland Urban Mainland Rural Zanzibar 68 41 34 47 48 56 50 8 11 7 2 5 1 1 1 16 Public facility Voluntary/religious sector Private facility At home
Assistance During Delivery (2010 TDHS) 51% of births were delivered by a skilled provider. No one 3% Relative/friend 29% Doctor/AMO 5% Clinical officer/assistant clinical officer 2% Percent distribution of births in the past 5 years Nurse/midwife 42% Trained TBA/TBA 15% *Skilled provider includes doctor/amo, clinical officer, assistant clinical officer, nurse/midwife, and MCH aide. MCH aide 2%
Postnatal Care (2010 TDHS) 31% of all mothers had a postnatal checkup within 2 days after delivery, as is recommended. 18% of all mothers had a postnatal checkup within 4 hours after delivery 65% of all mothers had no postnatal checkup within 41 days of delivery
Background of Delivery Care Services Availability of Services Service Readiness Management Practices and Training Signal Functions for Emergency Obstetric Care Newborn Care Practices 2014 Megan Ivankovich/WI-HER LLC, Courtesy of Photoshare
Availability of Maternal Health Services Percent of all facilities (N=1,188) offering: 85 76 75 4 4 ANC Normal Delivery Caesarean Delivery ANC and Normal Delivery All 3 Services
91 Availability of Maternal Health Services by Facility Type Percent of all facilities (N=1,188) offering: 91 85 Hospital Health centre Dispensary Clinic 94 85 75 84 30 26 11 0 0 ANC Normal delivery services C-section
Availability of Maternal Health Services by Managing Authority Percent of all facilities (N=1,188) offering: Government Private-for-profit Parastatal Faith-based 96 81 88 77 36 17 20 11 3 6 4 12 ANC Normal delivery services C-section
Availability of Delivery Service Provider Percent of facilities offering normal delivery services (N=905) that have: 60 28 Provider of delivery care available on-site or on-call 24 hours/day, with observed duty schedule Provider of delivery care available on-site or on-call 24 hours/day, with or without observed duty schedule
Background of Delivery Care Services Availability of Services Service Readiness Management Practices and Training Signal Functions for Emergency Obstetric Care Newborn Care Practices 2014 Megan Ivankovich/WI-HER LLC, Courtesy of Photoshare
Guidelines and Equipment for Delivery Services Percent of facilities offering normal delivery services (N=905) that have: Guidelines on BEmONC or CEmONC 30 Delivery pack Gloves 87 86 Neonatal bag and mask 76 Emergency transport Partograph 58 62 Suction apparatus 23 Examination light 14 Vacuum aspirator or D&C kit Manual vacuum extractor 5 7
Infection Control Percent of facilities offering normal delivery services (N=905) that have: Soap & running water or else alcoholbased hand disinfectant 67 Latex gloves 86 Sharps container 93 Waste receptacle 55
Essential Medicines for Delivery Percent of facilities offering normal delivery services (N=905) that have: Hospital Health centre Dispensary Clinic 97 88 76 94 53 36 30 35 87 67 34 39 76 57 54 64 81 72 58 68 86 69 43 84 Injectable uterotonic Injectable antibiotic Injectable magnesium sulphate Injectable diazepam Skin disinfectant IV fluids with infusion set
Essential Medicines for Newborns Percent of facilities offering normal delivery services (N=905) that have: Hospital Health centre Dispensary Clinic 46 65 81 88 83 76 85 69 52 53 73 60 73 34 26 18 14 11 16 23 Antibiotic eye ointment for newborn 4% chlorhexidine Injectable gentamicin Ceftriaxone powder for injection Amoxicillin suspension
Background of Delivery and Newborn Care Services Availability of Services Service Readiness Management Practices and Training Signal Functions for Emergency Obstetric Care Newborn Care Practices 2014 Megan Ivankovich/WI-HER LLC, Courtesy of Photoshare
Training and Supervision for Providers of Normal Delivery or Newborn Care Services Percent of interviewed providers of normal delivery or newborn care services (N=3,958) that received: In-service training related to delivery and/or newborn care during past 24 months Personal supervision during past 6 months 61 67 71 67 68 34 40 39 38 18 Hospital Health centre Dispensary Clinic Total
Training of Normal Delivery Providers: Delivery Care Percent of interviewed providers of normal delivery or newborn care services (N=3,958) that received: At any time During past 24 months IMPAC 7 14 Routine care for labour and delivery Active management of 3rd stage of labour Emergency obstetric care/lifesaving skills 10 10 10 21 22 21 Post-abortion care 7 15 Neonatal resuscitation 33 42
Training of Normal Delivery Providers: Immediate Newborn Care Percent of interviewed providers of normal delivery or newborn care services (N=3,958) that received: At any time During past 24 months Neonatal resuscitation and using bag and mask 33 42 Early and exclusive breastfeeding 25 34 Newborn infection management 19 25 Thermal care Sterile cord cutting and care 26 27 33 35 Kangaroo mother care for low birth weight babies 20 27
Background of Delivery and Newborn Care Services Availability of Services Service Readiness Management Practices and Training Signal Functions for Emergency Obstetric Care Newborn Care Practices 2014 Megan Ivankovich/WI-HER LLC, Courtesy of Photoshare
Signal Functions for Emergency Obstetric and Newborn Care Percent of facilities offering normal delivery services (N=905) that report they performed the signal functions for emergency obstetric care at least once during the 3 months before the survey Parenteral antibiotics 34 Parenteral oxytocics 84 Parenteral anticonvulsants 13 Assisted vaginal delivery 70 Manual removal of placenta Removal of retained products of conception 34 35 Neonatal resuscitation 52 Blood transfusion C-section 5 6
Signal Functions for Emergency Obstetric and Newborn Care Percent of facilities offering normal delivery services (N=905) that report they performed the signal functions for emergency obstetric care at least once during the 3 months before the survey Hospital Health centre Dispenary Clinic 84 97 91 82 94 78 60 62 27 32 7 8 Applied parenteral antibiotics Applied parenteral oxytocic Applied parenteral anticonvulsant
Background of Delivery and Newborn Care Services Availability of Services Service Readiness Management Practices and Training Signal Functions for Emergency Obstetric Care Newborn Care Practices 2014 Megan Ivankovich/WI-HER LLC, Courtesy of Photoshare
Newborn Care Practices Percent of facilities offering normal delivery services (N=905) that report they performed the indicated practice as a routine component of newborn care Drying and wrapping newborn to keep warm Initiation of breastfeeding within the 1st hour 98 98 Delivery to abdomen (skin-to-skin) 94 Routine complete examination of newborn before discharge Weighing newborn immediately upon delivery Giving newborn oral polio vaccine before discharge Giving newborn BCG vaccine before discharge Applying tetracycline eye ointment to both eyes 33 53 80 84 92
Newborn Care Practices (continued) Percent of facilities offering normal delivery services (N=905) that report they performed the indicated practice as a routine component of newborn care Kangaroo mother care 21 Suctioning newborn with suction bulb 46 Administration of vitamin K to newborn 3 Suctioning newborn with catheter 13 Giving full bath shortly after birth Giving newborn prelacteal liquids 2 1 Not recommended
Key Findings 76% of facilities provide normal delivery; 4% provide C-sections 62% of facilities that offer normal delivery care have emergency transport available 38% of providers received in-service training in delivery and/or newborn care services; 68% received personal supervision in last 6 months 84% of facilities that offer normal delivery care had administered parenteral oxytocic in the three months before the survey; 52% had carried out neonatal resuscitation 92% of facilities providing delivery services routinely perform a complete examination of the newborn before discharge