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Factors Associated With Mortality Among Hospitalized Adults With Covid-19 Pneumonia At A Private Tertiary Hospital In Tanzania: A Retrospective Cohort Study, Nadeem Kassam, Eric Aghan, Omar Aziz, Hanifa Mbithe, Kamran Hamid, Reena Shah, Salim Surani, James Orwa, Samina Somji

Internal Medicine, East Africa

Background: The emergence of the novel coronavirus disease 2019 (COVID-19) has caused millions of deaths worldwide. There has been paucity of data for hospitalized African patients suffering from COVID-19. This study aimed to identify factors associated with in-hospital mortality in patients suffering from COVID-19 in Tanzania.

Methods: This was a single center, retrospective, observational cohort study in adult patients hospitalized with confirmed COVID-19 infection. Demographics, clinical pattern, laboratory and radiological investigations associated with increased odds of mortality were analyzed.

Results: Of the 157 patients, 107 (68.1%) patients survived and 50 (31.8%) died. Mortality was highest in patients …

Perceptions Of Surgeons On Surgical Antibiotic Prophylaxis Use At An Urban Tertiary Hospital In Tanzania, Elizabeth Mmari, Eunice Pallangyo, Authar Ali, Dereck A. Kaale, Isaac Mawalla, Muzdalfat Abeid

General Surgery, East Africa

Background: Surgical Site Infections are a major cause of morbidity and mortality among operated patients. In spite of the accessibility of universal and national guidelines for surgical prophylaxis, recent studies surveying the present routine of prophylaxis have demonstrated overutilization of a wide range antibacterial medication for a single patient. Few studies have shown qualitatively factors influencing this and perceptions of surgeons on surgical antibiotic prophylaxis use. Unfortunately, none of these studies have been done in Tanzania.

Objective: To describe the perceptions of surgeons on surgical antibiotic prophylaxis use at an urban tertiary hospital.

Methods: A qualitative study …

Maternal Health Care Professionals’ Experiences And Views On The Use Of Obstetric Ultrasound In Rwanda: A Cross-Sectional Study, Ingrid Mogren, Joseph Ntaganira, Jean Paul Semasaka Sengoma, Sophia Holmlund, Rhonda Small, Lan Pham Thi, Hussein Kidanto, Matilda Ngarina, Cecilia Bergström, Kristina Edvardsson

Obstetrics and Gynaecology, East Africa

Background: This study, undertaken in Rwanda, aimed to investigate health professionals’ experiences and views on the following topics: current clinical guidelines for ultrasound from second trimester at the clinic, regional and national levels, and adherence to clinical guidelines; medically indicated ultrasound examinations; non-medical use of ultrasound including ultrasounds on maternal request; commercialisation of ultrasound; the value of ultrasound in relation to other clinical examinations in pregnancy; and ultrasound and medicalisation of pregnancy.

Methods: A cross-sectional design was adopted. Health professionals providing antenatal care and delivery services to pregnant women in 108 health facilities were invited to complete a survey, which …

Effect Of Lowering Tube Potential And Increase Iodine Concentration Of Contrast Medium On Radiation Dose And Image Quality In Computed Tomography Pulmonary Angiography Procedure: A Phantom Study, Justin E. Ngaile, Peter K. Msaki, Evarist M. Kahuluda, Furaha M. Chuma, Jerome M. Mwimanzi, Ahmed Jusabani

Imaging & Diagnostic Radiology, East Africa

The aim of the study was to examine the effect of lowering tube potential and increase iodine concentration on image quality and radiation dose in computed tomography pulmonary angiography procedure. The pulmonary arteries were simulated by three syringes. The syringes were filled with 1:10 diluted solutions of 300 mg, 350 mg and 370 mg of iodine per millilitre concentration in three water-filled phantoms simulating thin, intermediate and thick patients. The phantoms were scanned at 80 kVp, 110 kVp and 130 kVp and 0.6 second rotation time using a 16 slice computed tomography (CT) scanner. The tube current was either fixed …

Seroprevalence Of Hepatitis B Virus Infection, Anti-Hcv Antibodies And Hiv And Knowledge Among People Who Use Drugs Attending Methadone Therapy Clinic In Tanzania; A Cross-Sectional Study, Semvua B. Kilonzo, Daniel L W Gunda, David C. Majinge, Hyasinta Jaka, Paulina M. Manyiri, Fredrick Kalokola, Grahame Mtui, Elichilia R. Shao, Fatma Bakshi, Alex Stephano

Faculty of Health Sciences, East Africa

Background

Methadone therapy clinics have been recently introduced in Tanzania, aiming at reducing risk behaviors and infection rates of viral hepatitis and HIV among people who use drugs. The objective of this study was to estimate the prevalence, associated factors and knowledge level of these conditions among people who use drugs attending a methadone clinic in Tanzania.

Methods

We enrolled 253 People who using drugs receiving Methadone therapy. Clinical data was retrospectively collected from the medical records and face-to face interviews were conducted to determine the behavioral risk factors and respondents’ knowledge on viral hepatitis and HIV.

Results

An overall …

Translation And Validation Of Training Needs Analysis Questionnaire Among Reproductive, Maternal And Newborn Health Workers In Tanzania, Tumbwene Mwansisya, Columba Mbekenga, Kahabi Isangula, Loveluck Mwasha, Eunice Pallangyo, Grace Edwards, James Orwa, Michaela Mantel, Micheal Mugerwa, Leonard Subi, Secilia Mrema, David Siso, Edna Selestine, Marleen Temmerman

School of Nursing & Midwifery, East Africa

Background: Continuous professional development (CPD) has been reported to enhance healthcare workers’ knowledge and skills, improve retention and recruitment, improve the quality of patient care, and reduce patient mortality. Therefore, validated training needs assessment tools are important to facilitate the design of effective CPD programs.

Methods: A cross-sectional survey was conducted using self-administered questionnaires. Participants were healthcare workers in reproductive, maternal, and neonatal health (RMNH) from seven hospitals, 12 health centers, and 17 dispensaries in eight districts of Mwanza Region, Tanzania. The training needs analysis (TNA) tool that was used for data collection was adapted and translated into …

Expired Carbon Dioxide During Newborn Resuscitation As Predictor Of Outcome, Kari Holte, Hege Ersdal, Claus Klingenberg, Joar Eilevstjønn, Hein Stigum, Samwel Jatosh, Hussein Kidanto, Ketil Størdal

Faculty of Health Sciences, East Africa

Aim:

To explore and compare expired CO2 (ECO2) and heart rate (HR), during newborn resuscitation with bag-mask ventilation, as predictors of 24-h outcome.

Methods:

Observational study from March 2013 to June 2017 in a rural Tanzanian hospital. Side-stream measures of ECO2, ventilation parameters, HR, clinical information, and 24-h outcome were recorded in live born bag-mask ventilated newborns with initial HR < 120 bpm. We analysed the data using logistic regression models and compared areas under the receiver operating curves (AUC) for ECO2 and HR within three selected time intervals after onset of ventilation (0-30 s, 30.1-60 s and 60.1-300 s).

Results:

Among 434 included newborns (median birth weight 3100 g), 378 were alive at 24 h, 56 had died. Both ECO2 and HR were independently significant predictors of 24-h outcome, with no differences in AUCs. In the first 60 s …

Spontaneous Fetal Reduction In Triplets And Prolongation Of Twin Pregnancy For 111 Days As An Outpatient: A Case Report, Davis Rubagumya,, Munawar Kaguta, Ernie Mdachi, Muzdalfat Abeid, Hussein Kidanto

Faculty of Health Sciences, East Africa

Background:

Multiple gestation has been on the rise because of advancement in assisted reproductive technology. Triplet pregnancy is associated with fetal loss and preterm birth as its major complications. Spontaneous triplet pregnancy is rare. In the case of fetal loss, delayed interval delivery has been used to achieve delivery of the retained fetuses. There is no common approach to delayed interval delivery. Case A 31-year-old East African lady with spontaneous triplet pregnancy presented to our institution at gestation age of 19 weeks with features of threatened miscarriage. One fetus was miscarried, and delayed interval delivery was done as an …

Clinical Presentations Associated With Adverse Outcomes Among Patients Admitted With Dengue At A Tertiary Hospital In Dar Es Salaam., Nakiganda John Mkasa

Master of Medicine in Family Medicine

Introduction Dengue is one of the most important mosquito viral borne infections caused by four viral serotypes (DENV 1-4). In 2019 WHO named dengue as among the top ten global threats due to an increase in the number of cases worldwide. Tanzania is among the countries in Africa with multiple outbreaks; 2010, 2013-2014, and 2019. Dengue has variable clinical presentations ranging from nonspecific such as fever, joint pain, and fatigue to more serious such as hemorrhage and shock. Dengue can result in adverse outcomes such as ICU admissions and prolonged hospital stays. Clinical presentations associated with adverse outcomes have been …

The Contribution Of Dysphagia To Acute Stroke Morbidity And Mortality In Nigeria: A Prospective Study, O O. Olajide, Philip Adebayo, F T. Taiwo, M O. Owolabi, A Ogunniyi

Faculty of Health Sciences, East Africa

Background:

The assessment of time-trend morbidity and mortality in acute stroke is critical to clinical policy decisions and resource allocation.

Objectives:

To determine the prevalence of dysphagia in acute stroke and the impact of dysphagia on short term stroke outcome (30 days post-stroke).

Methods:

This was a prospective longitudinal study. Bedside screening for dysphagia modified Rankin score (MRS) and Barthel Index (BI) were performed on acute stroke patients on day 1, day 7, day 14 and day 30 after stroke to determine the frequency of dysphagia. Patients with dysphagia were then compared with age- and gender-matched controls (stroke patients without …

Testicular Torsion Induced By Epididymo-Orchitis: A Case Report, Ali Akbar Zehri, Allyzain Ismail, Philip Adebayo, Authar Ali

Faculty of Health Sciences, East Africa

Introduction and importance:

Acute scrotum is considered a urological emergency requiring early intervention depending on the cause. There are multiple causes of acute scrotum with testicular torsion being the most feared as delayed treatment leads to testicular loss. However, differentiating between epididymo-orchitis and torsion can be very difficult.

Case presentation: We present a case of an 18-year old male patient with 2 separate episodes of acute scrotum. He had epididymo-orchitis as the first presentation followed by testicular torsion 5 days later. To our knowledge this is the first case of testicular torsion secondary to epididymo-orchitis.

Clinical discussion: Differentiating between epididymo-orchitis …

Patients’ Perceptions And Understanding Of Pre-Operative Informed Consent In Tertiary Care Setting- Dar-Es-Salaam, Steven Michael Esanju

Master of Medicine in General Surgery

Background: Informed consent under the ethical principle of autonomy demonstrates patient’s agreement to have procedure/intervention done to them. Considering its importance in safeguarding human rights and autonomy, it is now mandatory to take informed consent before any surgery/procedure. Many studies have questioned whether informed consent is being taken in tr ue spirit that ensures proper understanding of the disclosed information or it is just adhered to as a medico legal formality. Globally, studies have demonstrated that majority of patients do not fully understand even small matters regarding their health i ncluding diagnosis, treatment modalities and possible associated risks, because of …

Secondary Hyperparathyroidism And Its Clinical And Biochemical Associated Factors In Patients On Maintenance Hemodialysis In Dar Es Salaam, Doris Samwel

Master of Medicine in Internal Medicine

Background: Chronic kidney disease affects 13.6% of adult people in Tanzania. Secondary hyperparathyroidism is associated with an increase in disability-adjusted life years, cardiovascular mortality, and all-cause mortality worldwide especially in patients on maintenance hemodialysis. Justification: In Tanzania, there is a lack of prevalence data of secondary hyperparathyroidism and the factors associated with it. Knowing the factors associated with it will help in the early screening of our patients and intervene early before its complications arise. Objectives: This study aimed to assess the magnitude of secondary hyperparathyroidism and its association with clinical and biochemical variables and further to measure the association …

Knowledge, Attitudes And Practice Of Venous Thromboembolism Risk Assessment Among Surgical Doctors In Tanzania, Biswalo Mugeta Yango

Master of Medicine in General Surgery

Introduction Surgical patients are at increased risk of venous thromboembolism due to the nature of their conditions and treatments. The incidence ranges from 61.3% to 64.9% in developed countries, compared to 43% in Africa. Although venous thromboembolism is fatal, it is potentially preventable. Physician-implemented risk assessment models reduce events by 70%. No country in sub-Sahara Africa has implemented a national venous thromboembolism risk assessment guideline. The subsequent burden is probably a reflection of low awareness and knowledge, negative attitudes, and substandard practice among physicians towards risk assessment. Justification In the current study, we assessed Tanzanian surgical doctors' knowledge, attitudes, and …

The Contribution Of Dysphagia To Acute Stroke Morbidity And Mortality In Nigeria: A Prospective Study, O O. Olajide, Philip Adebayo, F T. Taiwo, M O. Owolabi, A Ogunniyi

Internal Medicine, East Africa

Background: The assessment of time-trend morbidity and mortality in acute stroke is critical to clinical policy decisions and resource allocation.

Objectives: To determine the prevalence of dysphagia in acute stroke and the impact of dysphagia on short term stroke outcome (30 days post-stroke).

Methods: This was a prospective longitudinal study. Bedside screening for dysphagia modified Rankin score (MRS) and Barthel Index (BI) were performed on acute stroke patients on day 1, day 7, day 14 and day 30 after stroke to determine the frequency of dysphagia. Patients with dysphagia were then compared with age- and gender-matched controls (stroke patients without …

Outcomes Of Cardiac Surgery At The Aga Khan University Hospital Nairobi – A One Year Review, Nelly Joseph Kahamba

Master of Medicine in General Surgery

Background: Cardiovascular diseases are the number one cause of death worldwide where an estimated 17.9 million people die yearly, according to WHO. Most of this disease burden lies in the low and middle-income countries. Management of cardiovascular diseases can be medical and/or surgical. Open heart surgery is one among the major surgeries performed worldwide. It is well established in high income countries where up to 200,000 cardiac surgeries can be performed yearly. In low-income countries particularly sub-Saharan Africa where most of the disease burden is, there are about 22 centres that cater to this growing need for cardiac surgery. There …

Performance In Mortality Prediction Of Saps 3 And Mpm0-Iii Scores Among Adult Patients Admitted To The Icu Of A Private Tertiary Referral Hospital In Tanzania, Nadeem Kassam

Master of Medicine in Internal Medicine

Background Illness predictive scoring systems are significant and meaningful adjuncts of patient management in the intensive care unit. They assist in predicting patient outcomes, improve clinical decision making and provide insight into the effectiveness of care and management while optimizing the use of hospital resources. We evaluated mortality predictive performance of Simplified acute physiology score (SAPS 3) and Mortality probability models (MPM0-III) in predicting ICU outcome as well as identified disease pattern and clinical factors associated with increased mortality. Methods This was a retrospective cohort study of adult patients admitted to the Intensive Care Unit (ICU) of the Aga Khan …

Multiple-Micronutrient Supplementation In Pregnant Adolescents In Low- And Middle-Income Countries: A Systematic Review And A Meta-Analysis Of Individual Participant Data, Emily C. Keats, Nadia Akseer, Pravheen Thurairajah, Simon Cousens, Zulfiqar Ahmed Bhutta, Global Young Women’S Nutrition Investigators’ Group

Woman and Child Health

Context: Approximately 7.3 million births occur annually among adolescents in low- and middle-income countries. Pregnant adolescents constitute a nutritionally vulnerable group that could benefit from intervention to mitigate the mortality and adverse birth outcomes associated with adolescent pregnancy.
Objective: The aim of this systematic review and meta-analysis was to assess the following: (1) the effect of multiple-micronutrient (MMN) supplementation vs iron and folic acid (IFA) supplementation among adolescents on maternal morbidity, birth outcomes, and mortality outcomes, (2) the effects of MMN supplementation in adolescents compared with the effects in adult women, and (3) the effect modification, if any, of MMN …

Intimate Partner Violence Is A Barrier To Antiretroviral Therapy Adherence Among Hiv - Positive Women: Evidence From Government Facilities In Kenya, Bornice C. Biomndo, Alexander Bergmann, Nils Lahmann, Lukoye Atwoli

Internal Medicine, East Africa

Introduction: Intimate Partner Violence (IPV) is linked to low engagement with HIV management services and adverse clinical outcomes, including poor ART adherence. In sub-Saharan Africa, studies on pregnant/postpartum women and transactional sex workers have produced divergent evidence regarding IPV’s association with poor ART adherence. We investigate this association among a broad group of women.

Methods: We sampled 408 HIV-positive women receiving free ART from different types of HIV clinics at government health facilities, assessing for IPV exposure by a current partner, ART adherence rate, and other factors that affect ART adherence (e.g. education, disclosure). ART adherence rates were measured using …

The Last Frontier For Global Non-Communicable Disease Action: The Emergency Department—A Cross-Sectional Study From East Africa, Christine Ngaruiya, Mbatha Wambua, Thomas Kedera Mutua, Daniel Owambo, Morgan Muchemi, Kipkoech Rop, Kaitlin R. Maciejewski, Rebecca Leff, Mugane Mutua, Benjamin Wachira

Emergency Medicine, East Africa

Introduction: Deaths due to non-communicable diseases (NCDs) have surpassed those due to communicable diseases globally and are projected to do so in Africa by 2030. Despite demonstrated effectiveness in high-income country (HIC) settings, the ED is a primary source of NCD care that has been under-prioritized in Africa. In this study, we assess the burden of leading NCDs and NCD risk factors in Kenyan Casualty Department patients to inform interventions targeting patients with NCDs in emergency care settings.

Materials and methods: Using the WHO STEPwise approach to surveillance (STEPS) tool and the Personal Health Questionnaire (PHQ-9), we conducted a …

The Injustice Of Unfit Clinical Practice Guidelines In Low-Resource Realities, Nanna Maaløe, Anna Marie Rønne Ørtved, Jane Brandt Sørensen, Brenda Sequeira Dmello, Thomas Van Den Akker, Monica Lauridsen Kujabi, Hussein Kidanto, Tarek Mequid, Christian Bygbjerg, Jos Van Roosmalen, Dan Wolf Meyrowitsch, Natasha Housseine

Faculty of Health Sciences, East Africa

To end the international crisis of preventable deaths in low-income and middle-income countries, evidence-informed and cost-efficient health care is urgently needed, and contextualised clinical practice guidelines are pivotal. However, as exposed by indirect consequences of poorly adapted COVID-19 guidelines, fundamental gaps continue to be reported between international recommendations and realistic best practice. To address this long-standing injustice of leaving health providers without useful guidance, we draw on examples from maternal health and the COVID-19 pandemic. We propose a framework for how global guideline developers can more effectively stratify recommendations for low-resource settings and account for predictable contextual barriers of implementation …

Fetal Heart Rate Development During Labour, Jarle Urdal, Kjersti Engan, Trygve Eftestøl, Solveig H. Haaland, Benjamin Kamala, Paschal Mdoe, Hussein Kidanto, Hege Ersdal

Faculty of Health Sciences, East Africa

Background Fresh stillbirths (FSB) and very early neonatal deaths (VEND) are important global challenges with 2.6 million deaths annually. The vast majority of these deaths occur in low- and low-middle income countries. Assessment of the fetal well-being during pregnancy, labour, and birth is normally conducted by monitoring the fetal heart rate (FHR). The heart rate of newborns is reported to increase shortly after birth, but a corresponding trend in how FHR changes just before birth for normal and adverse outcomes has not been studied. In this work, we utilise FHR measurements collected from 3711 labours from a low and low-middle …

Professional Image Of Nursing And Midwifery In East Africa: An Exploratory Analysis, Eunice Ndirangu, Ahmed Sarki, Columba Mbekenga, Grace Edwards

School of Nursing & Midwifery, East Africa

Background: Evidence suggests that there is a negative image of nursing and midwifery that does not promote these professions as attractive career options. Furthermore, there is a paucity of studies documenting how nursing and midwifery is perceived in East Africa and where such studies exist they are country-specific. The aim of this study was to explore views regarding the image of nursing and midwifery among nurses and midwives in three East African countries, Kenya, Tanzania and Uganda.

Methods: An exploratory descriptive cross-sectional study administered online using Survey Monkey Questionnaires assessed the views and perceptions of nurses and midwives regarding the …

Library Newsletter : Spring 2021, Office Of The University Librarian

Office of the University Librarian Reports

CONTENT:

- Greetings

- COVID-19 : Changed the Library Scene

- Transforming AV-LRC to Digital Scholarship Centre

- Impressions by our Leaders

- Impressions by Students

- Technology in Place

- Upcoming Projects

- Obituary

Developing Students’ Curiosity Through Chemistry Hands-On Activities: A Case Of Selected Community Secondary Schools In Dar Es Salaam, Tanzania, Esther Kibga, Emmanuel Gakuba, John Sentongo

Institute for Educational Development, East Africa

Curiosity is the inner drive for learning or ‘hunger for learning’ which is among the twenty-firstcentury learning competencies. Students in their earliest stage ought to exhibit curiosity to stirup knowledge acquisition and exploration, yet the development of curiosity in the context of education is considered to be unusual. This research assesses how chemistry students develop and express curiosity in a hands-on learning environment. A sample of 169 senior three students from three community secondary schools in Dar es Salaam was involved in this study. Besides, the study examined how hands-on activities in chemistry lessons can be incorporated as a pedagogical …

Knowledge About Continuous Positive Airway Pressure Machine Usage Among Nurses At A Tertiary Hospital In Tanzania, Wilson Paulo Lomnyack, Tumbwene Mwansisya, Stewart Mbelwa, Kahabi Isangula, Zephania Saitabau Abraham

School of Nursing & Midwifery, East Africa

Introduction: Continuous Positive Airway Pressure (CPAP) provides an air pressure that maintains the patency of the airway in patients with a variety of breathing problems. Nurses provide the hour to hour management of patients who require CPAP. The aim of this study was to assess the knowledge of nurses about CPAP machine usage at the tertiary hospital in Tanzania which serves the largest number of patients who require CPAP.

Method: A hospital-based descriptive cross-sectional study was carried out from March to June 2019 at Muhimbili National Hospital (MNH) and Jakaya Kikwete Cardiac Institute (JKCI) where 149 nurses who consented …

F-Wave Parameters And Body Mass Index In Carpal Tunnel Syndrome, Philip Adebayo, Rose E. Mwakabatika

Faculty of Health Sciences, East Africa

Background

Severe carpal tunnel syndrome (CTS) readily lends itself to both clinical and electrophysiological recognition. The uncertainty sometimes is in identifying and quantifying motor involvement in mild and, perhaps, in moderate CTS. Our study aimed to evaluate F responses in mild and moderate CTS and determine the contribution of BMI to the F-wave parameters.

Methods A retrospective review of the clinical and electrophysiological data of patients with CTS seen at the clinical neurophysiology laboratory of Aga Khan Hospital, Dar es Salaam, between 1 August 2017 and 31 July 2019 was retrieved. Carpal tunnel syndrome was graded according to the electrophysiological …

Covid-19 And Teleneurology In Sub-Saharan Africa: Leveraging The Current Exigency, Philip Adebayo, Olusegun John Oluwole, Funmilola Tolulope Taiwo

Faculty of Health Sciences, East Africa

tion residing in rural areas that have poor access to medical experts. Despite having a ridiculously huge, underserved population, very few African countries currently have any form of sustained and organized telemedicine practice, and even fewer have dedicated tele-neurology services. The ongoing COVID-19 pandemic has proved to be one of the most significant disruptors of vital sectors of human endeavor in modern times. In the healthcare sector, there is an increasing advocacy to deliver non-urgent care via telemedicine. This paper examined the current state of tele-neurology practice and infrastructural preparedness in sub-Saharan Africa. Currently, there is over 70% mobile phone …

Using Mobile Phones To Improve Young People Sexual And Reproductive Health In Low And Middle-Income Countries: A Systematic Review To Identify Barriers, Facilitators, And Range Of Mhealth Solutions, Anam Shahil Feroz, Naureen Akber Ali, Adeel Khoja, Armish Asad, Sarah Saleem

Community Health Sciences

Background: Globally, reproductive health programs have used mHealth to provide sexual and reproductive health (SRH) education and services to young people, through diverse communication channels. However, few attempts have been made to systematically review the mHealth programs targeted to improve young people SRH in low-and-middle-income countries (LMICs). This review aims to identify a range of different mHealth solutions that can be used for improving young people SRH in LMICs and highlight facilitators and barriers for adopting mHealth interventions designed to target SRH of young people.
Methods: Databases including PubMed, CINAHL Plus, Science Direct, Cochrane Central, and grey literature were searched …

The Impact Of Introducing Ambulance And Delivery Fees In A Rural Hospital In Tanzania, Corinna Vossius, Estomih Mduma, Robert Moshiro, Paschal Mdoe, Jan Terje Kvaløy, Hussein Kidanto, Sara Lyanga, Hege Ersdal

Faculty of Health Sciences, East Africa

Background Access to health care facilities is a key requirement to enhance safety for mothers and newborns during labour and delivery. Haydom Lutheran Hospital (HLH) is a regional hospital in rural Tanzania with a catchment area of about two million inhabitants. Up to June 2013 ambulance transport and delivery at HLH were free of charge, while a user fee for both services was introduced from January 2014. We aimed to explore the impact of introducing user fees on the population of women giving birth at HLH in order to document potentially unwanted consequences in the period after introduction of fees. …