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Inspire : Vol 5, Issue 9, Department Of Medicine

INSPIRE – Department of Medicine Archives

• Message from the Chair
• Medicine at National and International Forums
• AKU – Flood Relief Task force
• DoM Grand Rounds – Dr Tazeen Jafar
• 2nd AKU Inter-professional certificate course in liver disease
• In-depth featuring Assistant Professor Endocrinology section Dr Sarah Nadeem
• Poem Section
• What are Academics Around the World Reading This Month?
• Publications

Diagnostic Challenge Of Perimenopause Molar Pregnancy In A 52-Year-Old Lady: Case Report, Willbroad Kyejo, Davis Rubagumya, Gregory Ntiyakuze, Nancy Matillya, Munawar Kaguta, Miriam Mgonja, Lynn Moshi

Family Medicine, East Africa

Introduction and importance: Gestational trophoblastic disease is an uncommon group of pregnancy-related dis- orders, with a course of trophoblastic proliferation, including hydatidiform mole (Agha et al., 2020), invasive and metastatic mole, choriocarcinoma, placental-site trophoblastic tumor, and epithelial trophoblastic tumor. Choriocarcinoma and trophoblastic tumor of the placenta are the most important tumors associated with pregnancy.

Case findings: A 52-year-old woman Para 2 Living 3, 3 years post-menopausal presented with prolong per vaginal bleeding for five weeks accompanied by lower abdominal pain. Diagnosis of gestational trophoblastic disease (choriocarcinoma type) was made by using beta HCG, radiology, and histology report. Patient underwent total …

Capacity Building Among Nursing And Midwifery Professional Associations In East Africa, Stephen Ruhmel, Eunice Ndirangu, Joseph Mwizerwa, Ahmed Sarki, Eunice Pallangyo

School of Nursing & Midwifery, East Africa

Background: Despite improvements in educational opportunities, policy changes, and pay raises in the nursing and midwifery professions in East Africa, poor working conditions, few professional development opportunities, and a general lack of respect for these professions predominate. These issues contribute to a low quality of care among a population with a high burden of communicable diseases. Health professional associations may help to address these challenges by providing a voice for nurses and midwives.

Objective: This study evaluated the impact of a 5-year programme focused on strengthening nurses’ and midwives’ professional associations in East Africa. Methods: This study used …

An Account Of The Methodological Implementation Of Design-Based Research In The Chemistry Classroom Context, Esther Kibga, Emmanuel Gakuba, John Sentongo

Institute for Educational Development, East Africa

Design-Based Research (DBR) has recently received a significant amount of attention in the educational research literature of the 21st century. This work analyses the understanding of DBR as the research methodology, why, and how it can be applied in educational research to bring a practical outcome and improve educational practices. Besides, this work reflects on a step-by-step implementation of the Hands-on Instructional Model (HIM) designed to enhance the development of chemistry learners’ curiosity and problem-solving skills. Also, it gives a detailed description of the two prototypes of the first alteration cycle. A sample of 169 Senior Three chemistry students was …

“Do Not Detach The Placenta From My Baby's Cord” - Lotus Birth Case Series From Tanzania Tertiary Hospital, Willbroad Kyejo, Davis Rubagumya, Christian Mwalo, Lynn Moshi, Munawar Kaguta, Miriam Mgonja, Shweta Jaiswal

Family Medicine, East Africa

Introduction: Lotus birth is seldom practiced, with its prevalence being not well documented. There is no clear existing guideline or pathway for this practice. Safety in delivery as well as caring for newborn and her mother is of paramount importance. Hence, clarity for Lotus delivery in any set up is indispensable.

Cases findings: We have described on case series approach to women who opted to delivery without detachment of placenta. We have described delivery characteristics, neonatal clinical course, cord, and placenta manage- ment. In year 2022 at our center, we have received two cases of lotus delivery.

Conclusion and …

Pregnancy Following Robot-Assisted Laparoscopic Bilateral Endometriotic Cystectomy Rare Case Report Of Endometriosis Stage Iv, Willbroad Kyejo, Ally Zain Ismail, Brenda Moshi, Gregory Ntiyakunze, Nancy Matillya, Munawar Kaguta

Family Medicine, East Africa

Introduction and importance: Endometriosis is a common cause of infertility in women. In this case report we explain successful conception in deep-infiltrating ovarian endometriosis following robot-assisted surgery and androgenic agonist treatment.

Case presentation: A 38-year-old current Para 2, Living 2 presented 8 years ago with chronic lower abdominal pain, dysmenorrhea, and delayed conception. Advance endometriosis was highly suspected from the history and examination. Robot-assisted laparoscopic partial cystectomy was performed for the deep-infiltrating ovarian endometriosis. She was then discharged with postoperative androgenic agonists and with timed intercourse, she got pregnant within 9 months.

Clinical discussion: Advanced endometriosis (Stage III or …

Factors Shaping Good And Poor Nurse-Client Relationships In Maternal And Child Care: A Qualitative Study In Rural Tanzania, Kahabi Isangula, Eunice Pallangyo, Columba Mbekenga, Eunice Ndirangu, Constance Shumba

School of Nursing & Midwifery, East Africa

Background: Evidence indicates that poor nurse‐client relationships within maternal and child health (MCH) continues to impact trust in formal healthcare systems, service uptake, continuity with care and MCH outcomes. This necessitates contextualized innovative solutions that places both nurses and clients at the forefront as agents of change in optimizing intervention designs and implementation. This study explored nurses and clients’ perspectives on the factors shaping nurse‐client relationships in MCH care to generate evidence to guide subsequent steps of human centered design (HCD) that involve designing effective strategies for improving therapeutic relationships in Shinyanga, Tanzania.

Methods: Qualitative descriptive design was …

Unit Knowledge And Practice Of Emergency Nursing Interventions At A Tertiary Public Cardiac Health Center In Uganda, Harriet Namukwaya, Cliff Asher Aliga, Grace Nakate, Judith Mutyabule

School of Nursing & Midwifery, East Africa

Background: Research suggests that many of the millions of deaths and long-term disabilities resulting from acute cardiovascular events and other emergency conditions are preventable if effective emergency care services were readily available. Effective emergency care requires trained and competent staff, including registered nurses. Most educational pathways do not adequately prepare nurses to deliver sensitive health care services for those with acute illness and injury. This includes Uganda, where few capacity-building initiatives have targeted emergency nursing care delivery, leading to knowledge and practice gaps.

Purpose: This study aimed to assess emergency nursing knowledge and clinical practice at a tertiary …

Bilateral Tubal Ectopic Gestation: Complication In A Patient With Previous Ectopic Pregnancy, Rare Case Report, Willbroad Kyejo, Davis Rubagumya, Zainab Fidaali, Ahmed Jusabani, Munawar Kaguta, Shweta Jaiswal

Family Medicine, East Africa

Introduction: Ectopic pregnancy results of implantation of conceptus outside of endometrial cavity. It remains an important cause of maternal mortality. Spontaneous bilateral tubal pregnancies are the rare form of ectopic and are considered spontaneous when no fertility treatments are involved. Case findings: A 31-year-old nulliparous woman presented at the Family Medicine Clinic with complaints of non- specific mild lower abdominal pain for 3 days and amenorrhea for 5 weeks. Transvaginal Ultrasound showed bilateral unruptured adnexa pregnancies. The trial of medical therapy was done without success and later lap- arotomy salpingostomy was done. One year later patient was able to …

A Cross-Sectional Study Of Self-Perceived Educational Needs Of Emergency Nurses In Two Tertiary Hospitals In Nairobi, Kenya, Anthony Ndung’U, Eunice Ndirangu, Ahmed Sarki, Lilian Isiaho

School of Nursing & Midwifery, East Africa

Background: Many low- and middle-income countries lack resources for well-functioning emergency care systems. Emer- gency nurses interact with injured and critically ill patients as the first contact in many health care settings. However, insuffi- cient training limits nurses from providing ideal emergency care. The purpose of this research was to highlight educational needs specific to nurses working in 2 emergency departments in Nairobi, Kenya.

Methods: A descriptive cross-sectional study involving emer- gency units of 2 of the largest referral and teaching hospitals (Aga Khan University Hospital, Nairobi, and Kenyatta National Hospital) in Nairobi, Kenya, was conducted. Data were …

Child Disability And Family-Centred Care In East Africa: Perspectives From A Workshop With Stakeholders And Health Practitioners, Pauline Samia, Susan Wamithi, Amina Kassam, Melissa Tirkha, Edward Kija, Ayalew Moges, Arnab Seal, Peter Rosenbaum, Robert Armstrong

Paediatrics and Child Health, East Africa

Background: Our understanding of child disability has undergone major changes over the last three decades transforming our approach to assessment and management. Globally there are significant gaps in the application of these 21st century models of care. There is recognition that economic, cultural, and social factors influence transitions in care and there is need to consider contextual factors.

Objectives: A two-day workshop brought together key stakeholders to discuss current models of care and their application in the East African context. This article summarises workshop proceedings and identifies a broadly supported set of recommendations that serve to set a …

Prevalence & Factors Associated With Acute Kidney Injury In Patients Undergoing Percutaneous Coronary Intervention At A Tertiary Healthcare Facility In Tanzania, Faisal Hooda

Master of Medicine in Internal Medicine

Background: Acute kidney injury is a potentially fatal but preventable outcome of percutaneous coronary intervention: the most plausible cause being radiocontrast-induced nephropathy; others include: pre-existing renal insufficiency from underlying illnesses and also acute renal insult caused by hypoperfusion from cardiac causes. The prevalence, associated risk factors and outcomes of AKI post-PCI are unclear and unexplored in our setting. Objectives: The study sought to determine the prevalence of acute kidney injury post-percutaneous coronary intervention at The Aga Khan Hospital, Dar es Salaam, Tanzania. Secondary objectives included: factors associated, with and outcomes of acute kidney injury (AKI) post percutaneous coronary intervention (PCI). …

Epilepsy Research In Africa: A Scoping Review By The Ilae Pediatric Commission Research Advocacy Task Force, Pauline Samia, Jane Hassell, Jessica Hudson, Azim Ahmed, Jasmit Shah, Charles Hammond, Edward Kija, Stéphane Auvin, Jo Wilmshurst

Paediatrics and Child Health, East Africa

Objective: Despite the high prevalence of epilepsy in Africa, evaluation of epi- lepsy research trends on the continent is lacking. Without establishing effective research, improvement in care for people with epilepsy cannot be effectively strategized or targeted.

Methods: A scoping review of the peer-reviewed literature on epilepsy from Africa (1989–2019) was conducted. The aim was to understand from this what areas are well researched versus underresearched based on published epilepsy topics.

Results: A total of 1227 publications were identified and assessed. A significant increase in publications occurred over the 30 years assessed. African author lead- ership was …

Authorship Representation In Global Emergency Medicine: A Bibliometric Analysis From 2016 To 2020, Stephanie Chow Garbern, Gimbo Hyuha, Catalina González Marqués, Noor Baig, Jennifer L. Chan, Sanjukta Dutta, Masuma A. Gulamhussein, Gloria Paulina López Terán, Hussein Karim Manji, Benjamin Wachira

Emergency Medicine, East Africa

Introduction: High-income country (HIC) authors are disproportionately represented in authorship bylines compared with those affiliated with low and middle-income countries (LMICs) in global health research. An assessment of authorship representation in the global emergency medicine (GEM) literature is lacking but may inform equitable academic collaborations in this relatively new field.

Methods: We conducted a bibliometric analysis of original research articles reporting studies conducted in LMICs from the annual GEM Literature Review from 2016 to 2020. Data extracted included study topic, journal, study country(s) and region, country income classification, author order, country(s) of authors' affiliations and funding sources. We compared the …

Shortness Of Breath In A Young Lady, Rare Case Report Of Thoracic Endometriosis, Willbroad Kyejo, Ally Zain Ismail, Davis Rubagumya, Rahma Bakari, Munawar Kaguta, Nancy Matillya

Family Medicine, East Africa

Introduction and importance: Endometrial glandular tissue can implant in the thorax of women suffering from endometriosis. The clinical presentation is depends on site of implantation. Complications include pneumothorax, pneumohemothorax or hemothorax.

Case presentation: A 31 year old woman with history of infertility presented with shortness of breath and was found to have a significant right sided pneumohemothorax. Drainage was done followed by chemical pleurodesis using bleomycin with resolution of symptoms on her follow up.

Clinical discussion: Thoracic endometriosis tend to present with chronic or sub-acute symptoms which are nonspecific symptoms leading to late diagnosis. Video Assisted Thoracoscopic surgery offer both …

Fetal Movement Trials: Where Is The Evidence In Settings With A High Burden Of Stillbirths?, Natasha Housseine, Joyce Browne, Nanna Maaløe, Brenda Sequeira Dmello, Sam Ali, Muzdalfat Abeid, Tarek Meguid, Marcus J. Rijken, Hussein Kidanto

Obstetrics and Gynaecology, East Africa

No abstract provided.

The Impact Of Training On Self-Reported Performance In Reproductive, Maternal, And Newborn Health Service Delivery Among Healthcare Workers In Tanzania: A Baseline- And Endline-Survey, Tumbwene Mwansisya, Columba Mbekenga, Kahabi Isangula, Loveluck Mwasha, Stewart Mbelwa, Mary Lyimo, Lucy Kisaka, Victor Mathias, Eunice Pallangyo, Grace Edwards, Michaela Mantel, Sisawo Konteh, Thomas Rutachunzibwa, Marleen Temmerman

School of Nursing & Midwifery, East Africa

Background: Delivery of quality reproductive health services has been documented to depend on the availability of healthcare workers who are adequately supported with appropriate training. However, unmet training needs among healthcare workers in reproductive, maternal, and newborn health (RMNH) in low-income countries remain disproportionately high. This study investigated the effectiveness of training with onsite clinical mentorship towards self-reported performance in RMNH among healthcare workers in Mwanza Region, Tanzania.

Methods: The study used a quasi-experimental design with pre-and post-intervention evaluation strategy. The baseline was compared with two endline groups: those with intervention (training and onsite mentorship) and those without. The differences …

Interventions For Prevention Of Non-Communicable Diseases Among Adolescents Living With Hiv: A Systematic Review, Eunice Ndirangu, Constance Shumba, Peter Gatiti, Bernard Mutwiri, Amina Abubakar

School of Nursing & Midwifery, East Africa

While the uptake of antiretroviral drugs has rapidly expanded among adolescents and adults living with HIV, research evidence suggests that people living with HIV have a higher risk of non-communicable diseases (NCDs). With more than 35% of the global burden of NCDs stemming from adolescence, there is a need to comprehend the existing evidence on early prevention, detection, and disease management, especially among the at-risk population. In line with the WHO Global Action Plan, 2013–2020 and “Best Buys”, recommendations on practical interventions for NCDs prevention, this systematic review seeks to synthesise evidence on the current interventions for preventing NCDs among …

What Motivates The Choice Of Specialty Among Medical Doctors In Tanzania, Thabit Ramadhani

Master of Surgery

Background: Studies have shown there is a low specialist workforce, coupled with wide range of disparity among different specialities in the country to cater for the needs of more than 54 million Tanzanians. The theories of motivation and development have shown many theories influencing choices made by people in life. Objectives: This study aims to assess the motivation for choice of specialty among medical doctors (including registrars, residents, and specialists) in Dar es Salaam, Tanzania. Methods: A descriptive cross-sectional study was conducted at Muhimbili University of Health and Allied Sciences, Muhimbili National hospital, and the Aga Khan University Hospital Dar …

Validation Of The Kiswahili Version Of The Migraine Disability Assessment Scale In Dar Es Salaam, Tanzania, Aliasger Nagri

Master of Internal Medicine

Background: Migraine is a chronic paroxysmal neurological disorder characterized by multiphase attacks of head pain and many neurological symptoms. The MIDAS is a five (5) question-based questionnaire used in clinical practices to identify the disability caused by migraine at work, school, household or social life; with a score indicating little or no disability (0-5), mild disability (6-10), moderate disability (11-20), and severe disability (21+). Translated versions of the MIDAS scale in a number of languages has been validated. Translating and validating the Kiswahili version of the MIDAS questionnaire is essential and needed to ensure its comparability to the original English …

Nurses’ Attitudes Towards Hospitalized Older Adults In A Tertiary Care Setting In Ghana, Yakubu H. Yakubu, Abdul-Ganiyu Fuseini, Eleanor Holroyd

School of Nursing & Midwifery, East Africa

Introduction: The increasing population of older adults and rapid increases in co- morbidities globally has necessitated the need for a healthcare delivery system that meets the multifaceted needs of the growing population of older adults. Concurrent with these rising complex health needs is the importance of positive, non-judgmental attitudes of health services providers towards older adults. Moreover, this is particu-larly important in the nursing profession, given nurses' significant and crucial roles in healthcare settings.

Aim: The study aimed to evaluate nurses’ attitudes towards older adults in a tertiary hospital in Ghana.

Design: It employed a descriptive cross-sectional …

Early Neonatal Mortality Is Modulated By Gestational Age, Birthweight And Fetal Heart Rate Abnormalities In The Low Resource Setting In Tanzania – A Five Year Review 2015–2019, Aisa Shayo, Pendo Mlay, Emily Ahn, Hussein Kidanto, Michael Espiritu, Jeffrey Perlman

Obstetrics and Gynaecology, East Africa

Background: Early Neonatal mortality (ENM) (<7days) remains a signifcant problem in low resource settings. Birth asphyxia (BA), prematurity and presumed infection contribute signifcantly to ENM. The study objectives were to determine: frst, the overall ENM rate as well as yearly ENM rate (ENMR) from 2015 to 2019; second, the infuence of decreasing GA (<37weeks) and BW (<2500g) on ENM; third, the contribution of intrapartum and delivery room factors and in particular fetal heart rate abnormalities (FHRT) to ENM; and fourth, the Fresh Still Birth Rates (FSB) rates over the same time period.

Methods: Retrospective cohort study undertaken in a zonal referral teaching hospital located in Northern Tanzania. Labor and delivery room data were obtained from 2015 to 2019 and included BW, GA, fetal heart rate (FHRT) abnormalities, bag mask ventilation (BMV) during resuscitation, initial temperature, and antenatal steroids use. Abnormal outcome was ENM<7days. Analysis included t tests, odds ratios (OR), and multivariate regression analysis.

Results: The overall early neonatal mortality rate (ENMR) was 18/1000 livebirths over the 5 years and did not change signifcantly comparing 2015 to 2019. Comparing year 2018 to 2019, the overall ENMR decreased signifcantly (OR 0.62; 95% confdence interval (CI) …

Adequacy Of Pain Management Among Advanced Cancer Patients With Solid Tumors Attending Palliative Care Centers In Dar Es Salaam, Judith Mwijage

Master of Medicine in Family Medicine

Background: Cancer pain is a universal undesirable symptom among cancer patients that if not addressed causes suffering and impedes quality of life of both the patients and their family. Observational studies available have shown increase in palliative care programs in Tanzania but there is dearth of information regarding the adequacy of pain control among patients with cancer after the initiation of these programs and improvement of the available interventions. Objectives: This study aimed to determine adequacy of pain management among advanced cancer patients with solid tumors as well as factors affecting adequate Cancer Related Pain management. Methods: We conducted a …

Tuberculous Meningitis Presenting With Stroke In An Immunocompetent Adolescent: A Case Report, Rukhsar S. Osman, Rahim Damji, Zainab Fidaali, Nahida Z. Walli, Mariam Noorani

Paediatrics and Child Health, East Africa

Background: Tuberculous meningitis (TBM) is a severe infection of the central nervous system that has high mortality. The disease predominantly affects young children and those who are immuncompromised. Strokes have been reported in about one-third of children with tuberculous meningitis and are associated with poor clinical outcomes.
Case report: A previously healthy 14-year-old girl living in Dar es Salam, Tanzania presented with one month history of weight loss associated with weakness, loss of appetite, apathy; without respiratory symptoms. Anti-TB therapy was started, based on radiological findings of the chest which showed multiple patchy centrilobular nodules with linear branching …

Healthcare Providers' Experiences With A Clinical Mentorship Intervention To Improve Reproductive, Maternal And Newborn Care In Mwanza, Tanzania, Kahabi Isangula, Columba Mbekenga, Tumbwene Mwansisya, Loveluck Mwasha, Lucy Kisaka, Edna Selestine, David Siso, Thomas Rutachunzibwa, Secilia Mrema, Eunice Pallangyo

School of Nursing & Midwifery, East Africa

Introduction: There is increasing evidence suggesting that clinical mentorship (CM) involving on-the-job training is one of the critical resources—friendly entry points for strengthening the knowledge and skills of healthcare providers (HCPs), which in turn facilitate the delivery of effective reproductive, maternal, and newborn health (RMNH) care. The article explores the experiences of HCPs following participation in the CM program for RMNH in eight districts of Mwanza Region in Tanzania.

Materials and Methods: A qualitative descriptive design employing data from midterm project review meetings and Key Informant Interviews (KIIs) with purposefully selected HCPs (mentors and mentees) and District Medical Officers (DMOs) …

Heterotopic Gestation In Polycystic Ovary Disease: Termination Of Tubal Pregnancy And Intrauterine Pregnancy Progressing To Term, Munawar Kaguta, Ahmed Jusabani, Ntiyakuze Gregory, Shweta Jaiswal, Zainab Fidaali, Pilly Ally, Davis Rubagumya, Miriam Mgonja, Farhat Seif

Faculty of Health Sciences, East Africa

Heterotopic pregnancy is rare. We report a 27-year-old lady with polycystic ovarian disease. She presented at our health facility with acute abdomen. Her evaluation revealed heterotopic pregnancy. High index of suspicion for heterotopic pregnancy in any woman with early pregnancy presenting with acute abdomen is crucial. Therefore, correct and early diagnosis allows appropriate management while it preserves the intrauterine pregnancy as in the index case.

Scaling Up Context-Tailored Clinical Guidelines And Training To Improve Childbirth Care In Urban, Low-Resource Maternity Units In Tanzania: A Protocol For A Stepped-Wedged Cluster Randomized Trial With Embedded Qualitative And Economic Analyses (The Partoma Scale-Up Study), Nanna Maaløe, Natasha Housseine, Jane Brandt Sørensen, Josephine Obel, Brenda Sequeira Dmello, Monica Lauridsen Kujabi, Haika Osaki, Thomas Wiswa John, Rashid Saleh Khamis, Zainab Suleiman Said Muniro, Daniel Joseph Nkungu, Britt Pinkowski Tersbøl, Flemming Konradsen, Sangeeta Mookherji, Columba Mbekenga, Tarek Meguid, Jos Van Roosmalen, Ib Christian Bygbjerg, Thomas Van Den Akker, Andreas Kryger Jensen, Morten Skovdal, Hussein Kidanto, Dan Wolf Meyrowitsch

Faculty of Health Sciences, East Africa

While facility births are increasing in many low-resource settings, quality of care often does not follow suit; maternal and perinatal mortality and morbidity remain unacceptably high. Therefore, realistic, context-tailored clinical support is crucially needed to assist birth attendants in resource-constrained realities to provide best possible evidence-based and respectful care. Our pilot study in Zanzibar suggested that co-created clinical practice guidelines (CPGs) and low-dose, high-frequency training (PartoMa intervention) were associated with improved childbirth care and survival. We now aim to modify, implement, and evaluate this multi-faceted intervention in five high-volume, urban maternity units in Dar es Salaam, Tanzania (approximately 60,000 births …

Heterotopic Gestation In Polycystic Ovary Disease: Termination Of Tubal Pregnancy And Intrauterine Pregnancy Progressing To Term, Munawar Kaguta, Ahmed Jusabani, Ntiyakuze Gregory, Shweta Jaiswal, Zainab Fidaali, Pilly Ally, Davis Rubagumya, Miriam Mgonja, Farhat Seif

Obstetrics and Gynaecology, East Africa

Heterotopic pregnancy is rare. We report a 27-year-old lady with polycystic ovarian disease. She presented at our health facility with acute abdomen. Her evaluation revealed heterotopic pregnancy. High index of suspicion for heterotopic pregnancy in any woman with early pregnancy presenting with acute abdomen is crucial. Therefore, correct and early diagnosis allows appropriate management while it preserves the intrauterine pregnancy as in the index case.

The Dangers Of Being Old In Rural Tanzania: A Call For Interventions For Strengthening Palliative Care In Low-Income Communities, Kahabi Isangula

School of Nursing & Midwifery, East Africa

Tanzania is currently implementing political reforms that, with time, are expected to improve quality of life among individuals regardless of their age. This improvement in quality of life, consequently prolonged life expectancy implies that the aging population will significantly increase in a few years to come. Research projects that the number of people aged 60 years and above will increase from the current 4- percent to 10-percent of the total population by 2050 (United Republic of Tanzania, 2003; Kivelia and Kirway, 2011; Morrissette andWane, 2012). The projected increase suggests that the older population will be at a disadvantage because majority …

Scaling Up Context-Tailored Clinical Guidelines And Training To Improve Childbirth Care In Urban, Low-Resource Maternity Units In Tanzania: A Protocol For A Stepped-Wedged Cluster Randomized Trial With Embedded Qualitative And Economic Analyses (The Partoma Scale-Up Study), Nanna Maaløe, Natasha Housseine, Jane Brandt Sørensen, Josephine Obel, Brenda Sequeira D'Mello, Monica Lauridsen Kujabi, Haika Osaki, Thomas Wiswa John, Rashid Saleh Khamis, Hussein Kidanto

Obstetrics and Gynaecology, East Africa

While facility births are increasing in many low-resource settings, quality of care often does not follow suit; maternal and perinatal mortality and morbidity remain unacceptably high. Therefore, realistic, context-tailored clinical support is crucially needed to assist birth attendants in resource-constrained realities to provide best possible evidence-based and respectful care. Our pilot study in Zanzibar suggested that co-created clinical practice guidelines (CPGs) and low-dose, high-frequency training (PartoMa intervention) were associated with improved childbirth care and survival. We now aim to modify, implement, and evaluate this multi-faceted intervention in five high-volume, urban maternity units in Dar es Salaam, Tanzania (approximately 60,000 births …