Papers by Godfrey Mbaruku
Tropical Medicine & International Health, 2015
To examine factors associated with home delivery among women in Pwani Region, Tanzania, which has... more To examine factors associated with home delivery among women in Pwani Region, Tanzania, which has experienced a rapid rise in facility delivery coverage. Cross-sectional data from a population-based survey of women residing in rural areas of Pwani Region were linked to health facility locations. We fitted multi-level logistic models to examine individual and community factors associated with home delivery. 752 (27.95%) of the 2691 women who completed the survey delivered their last child at home. Women were less likely to deliver at home if they had any primary education (odds ratio [OR] 0.62; 95% confidence interval [CI]: 0.50, 0.79), were primiparous (OR: 0.52; 95% CI: 0.37, 0.73), had more exposure to media (OR: 0.80; 95% CI: 0.66, 0.96), or had received more (OR: 0.78; 95% CI: 0.63, 0.96) or better quality antenatal care (ANC) services (OR: 0.48; 95% CI: 0.34, 0.67). Increased wealth was strongly associated with lower odds of home delivery (OR: 0.27; 95% CI: 0.18, 0.39), as was living in a village that grew cash crops (OR: 0.56; 95% CI: 0.35, 0.88). Farther distance to hospital, but not to lower level facilities, was associated with higher likelihood of home delivery (OR 2.49; 95% CI: 1.60, 3.88). Poverty, multiparity, weak ANC, and distance to hospital were associated with persistence of home delivery in a region with high coverage of facility delivery. A pro-poor path to universal coverage of safe delivery requires a greater focus on quality of care and more intensive outreach to poor and multiparous women. This article is protected by copyright. All rights reserved.
BMC Health Services Research, 2014
The American journal of …, 2001
Anemia-specific mortality was markedly elevated among refugee children Ͻ 5 years of age in Tanzan... more Anemia-specific mortality was markedly elevated among refugee children Ͻ 5 years of age in Tanzania. In a randomized, double-blind study, 215 anemic children were initially treated for malaria and helminth infection and then received 12 weeks of thrice-weekly oral iron and folic acid. Group I received placebo and chloroquine treatment for symptomatic malaria infection (i.e., no presumptive anti-malarial treatment given). Group II received placebo and monthly presumptive treatment with sulfamethoxazole-pyrimethamine (SP). Group III also received monthly SP and thrice-weekly vitamins A and C (VAC). Mean hemoglobin concentration increased from 6.6 to 10.2 g/dL, with no significant differences among groups. Group II had lower mean serum transferrin receptor levels (TfR) than group I [P ϭ 0.023]. A greater proportion of participants in group III had normal iron stores (TfR Ͻ 8.5 g/ mL) than in group II [P ϭ 0.012]. Initial helminth and malaria treatment, followed by thrice-weekly iron and folic acid supplements resulted in increased hemoglobin levels. Monthly SP and thrice-weekly VAC contributed to improve iron stores. Monthly SP may have a role in situations where asymptomatic disease is prevalent or where access to care is limited. Because administration of VAC also hastened recovery of iron stores over administration of monthly SP alone, health care personnel could add VAC to the treatment for moderate anemia if maximum recovery of iron stores is desired.
African journal of reproductive health, 2003
Maternal mortality in Kigoma Region, western Tanzania, was assessed as part of ongoing efforts to... more Maternal mortality in Kigoma Region, western Tanzania, was assessed as part of ongoing efforts to reduce maternal deaths in the area. A sisterhood survey was carried out using a questionnaire in which respondents were asked about their sisters who died during pregnancy, childbirth or within six weeks after childbirth. Three thousand and twenty nine individuals were interviewed. The overall estimated maternal mortality ratio (MMR) in Kigoma Region was 606 per 100,000 live births (95% CI 518-695). In urban areas, the MMR was 447 (95% CI 262-635), compared to 638 (95% CI 539-737) in rural areas. The highest MMR of 757 was found in Kigoma rural district, the most isolated part of the region (95% CI 599-916). Although the differences are not statistically significant, they may indicate poor accessibility as a risk factor. Maternal mortality in Kigoma is high when compared to other regions in Tanzania. The sisterhood method is relatively simple and convenient for estimating maternal mortality in resource-poor countries. (Afr J Reprod Health 2003; 7[3]: 84-91) RÉSUMÉ Estimations de la mortalité maternelle en Tanzanie de l'ouest à travers la méthode de recueillir des renseignements auprés des soeurs des femmes interviewees. Nous avons évalué la mortalité maternelle dans la région de Kigoma, en Tanzanie de l'ouest dans le cadre des efforts en cours vers la réduction des décès maternels dans la région. Une enquête basée sur les renseignements sur les soeurs des femmes interviewées a été menée à l'aide d'un questionnaire sur lequel les gens interviewés ont répondu aux questions portant sur leurs soeurs mortes pendant la grossesse, l'accouchement ou moins de six semaines après l'accouchement. Trois mille vingt-neuf individus ont été interviewés. Les estimations globales de rapport de la mortalité maternelle (RMM) dans la région de Kigoma était de 606 pour 100,000 naissances vivantes (95% CI 262-635) par rapport à 638 (95% CI 539-737) dans les régions rurales. Le RMM le plus élevé qui était de 757, a été trouvé dans le district rural de Kigoma qui est la partie la plus isolée de la région (95% CI 599-916). Bienque les différences ne sont pas significatives du point de vue statistique, elles peuvent quand-même indiquer que le mauvais accès est un facteur de risque. La mortalité maternelle à Kigoma est élevée par rapport à d'autres régions en Zambie. L'approche basée sur les renseignement sur des soeurs est relativemnt simple et convenable pour l'évaluation de la mortalité maternelle dans les pays pauvres en ressources. (Rev Afr Santé Reprod 2003; 7[3]: 84-91)
African journal of reproductive health, 2009
This paper evaluates the safety and acceptability of long-term community-based use of misoprostol... more This paper evaluates the safety and acceptability of long-term community-based use of misoprostol for management of postpartum hemorrhage (PPH) in home-births, by comparing deliveries with and without misoprostol use in communities of Kigoma, Tanzania. We administered a standardized survey instrument to women who delivered between August 2004 and May 2007. 940 women completed questionnaires, corresponding to 950 deliveries. Findings showed that the majority of TBAs administered misoprostol at the correct time (76%). Receipt of three or five tablets was most commonly reported (47% and 43% respectively). Misoprostol users were significantly more likely to experience shivering, high temperature, nausea, and vomiting after delivery; adjustment for gynecological history and delivery characteristics revealed no significant differences in experience of symptoms. Misoprostol was highly acceptable to all women surveyed. Misoprostol at the community level is a safe intervention.
Bulletin of the World Health Organization, 2014
To measure the extent, determinants and results of bypassing local primary care clinics for child... more To measure the extent, determinants and results of bypassing local primary care clinics for childbirth among women in rural parts of the United Republic of Tanzania. Women were selected in 2012 to complete a structured interview from a full census of all 30076 households in clinic catchment areas in Pwani region. Eligibility was limited to those who had delivered between 6 weeks and 1 year before the interview, were at least 15 years old and lived within the catchment areas. Demographic and delivery care information and opinions on the quality of obstetric care were collected through interviews. Clinic characteristics were collected from staff via questionnaires. Determinants of bypassing (i.e. delivery of the youngest child at a health centre or hospital without provider referral) were analysed using multivariate logistic regression. Bypasser and non-bypasser birth experiences were compared in bivariate analyses. Of 3019 eligible women interviewed (93% response rate), 71.0% (2144) delivered in a health facility; 41.8% (794) were bypassers. Bypassing likelihood increased with primiparity (odds ratio, OR: 2.5; 95% confidence interval, CI: 1.9-3.3) and perceived poor quality at clinics (OR: 1.3; 95% CI: 1.0-1.7) and decreased if clinics recently underwent renovations (OR: 0.39; 95% CI: 0.18-0.84) and/or performed ≥ 4 obstetric signal functions (OR: 0.19; 95% CI: 0.08-0.41). Bypassers reported better quality of care on six of seven quality of care measures. Many pregnant women, especially first-time mothers, choose to bypass local primary care clinics for childbirth. Perceived poor quality of care at clinics was an important reason for bypassing. Primary care is failing to meet the obstetric needs of many women in this rural, low-income setting.
Bulletin of the World Health Organization, 2014
Bull World Health Organ 2014;92:915-917| doi: http://dx.doi.org/10.2471/BLT.14.137869 916
Page 1. From Department of Public Health Sciences Division of International Health (IHCAR) Karoli... more Page 1. From Department of Public Health Sciences Division of International Health (IHCAR) Karolinska Institutet, Stockholm, Sweden ENHANCING SURVIVAL OF MOTHERS AND THEIR NEWBORNS IN TANZANIA Godfrey Mbaruku Stockholm 2005 Page 2. ...
Anemia-specific mortality was markedly elevated among refugee children Ͻ 5 years of age in Tanzan... more Anemia-specific mortality was markedly elevated among refugee children Ͻ 5 years of age in Tanzania. In a randomized, double-blind study, 215 anemic children were initially treated for malaria and helminth infection and then received 12 weeks of thrice-weekly oral iron and folic acid. Group I received placebo and chloroquine treatment for symptomatic malaria infection (i.e., no presumptive anti-malarial treatment given). Group II received placebo and monthly presumptive treatment with sulfamethoxazole-pyrimethamine (SP). Group III also received monthly SP and thrice-weekly vitamins A and C (VAC). Mean hemoglobin concentration increased from 6.6 to 10.2 g/dL, with no significant differences among groups. Group II had lower mean serum transferrin receptor levels (TfR) than group I [P ϭ 0.023]. A greater proportion of participants in group III had normal iron stores (TfR Ͻ 8.5 g/ mL) than in group II [P ϭ 0.012]. Initial helminth and malaria treatment, followed by thrice-weekly iron and folic acid supplements resulted in increased hemoglobin levels. Monthly SP and thrice-weekly VAC contributed to improve iron stores. Monthly SP may have a role in situations where asymptomatic disease is prevalent or where access to care is limited. Because administration of VAC also hastened recovery of iron stores over administration of monthly SP alone, health care personnel could add VAC to the treatment for moderate anemia if maximum recovery of iron stores is desired.
Health Policy and Planning, 1995
An intervention programme aiming at a reduction of maternal deaths in the Regional Hospital, Kigo... more An intervention programme aiming at a reduction of maternal deaths in the Regional Hospital, Kigoma, Tanzania, is analyzed. A retrospective study was carried out from 1984-86 to constitute a background for an intervention programme in 1987-91. The retrospective study revealed gross under-registration of data and clarified a number of potentially useful issues regarding avoidable maternal mortality. An intervention programme comprising 22 items was launched and the maternal mortality ratio was carefully followed in 1987-91. The intervention programme paid attention to professional responsibilities with regular audit-oriented meeting, utilization of local material resources, schedules for regular maintenance of equipment, maintenance of working skills by regular on-the-job training of staff, norms for patient management, provision of blood, norms for referral of severely ill patients, use of antibiotics, regular staff evaluation, public complaints about patient management, travel distance of all essential staff to the hospital, supply of essential drugs, the need of a small infusion production unit, the creation of culture facilities for improved quality of microbiology findings, and to efforts to stimulate local fund-raising. The results indicate that the maternal mortality ratio fell from 933 to 186 per 100,000 live births over the period 1984-91. Thus it is underscored that the problem of maternal mortality can be successfully approached by a low-cost intervention programme aiming at identifying issues of avoidability and focusing upon locally available problem solutions.
International Journal of Gynecology & Obstetrics - INT J GYNECOL OBSTET, 2011
a b s t r a c t a r t i c l e i n f o Keywords: Emergency obstetric care Mid-level provider Non-p... more a b s t r a c t a r t i c l e i n f o Keywords: Emergency obstetric care Mid-level provider Non-physician clinician Surgery Tanzania
International Journal for Equity in Health, 2012
Objective: To explore the equity of utilization of inpatient health care at rural Tanzanian healt... more Objective: To explore the equity of utilization of inpatient health care at rural Tanzanian health centers through the use of a short wealth questionnaire.
Conflict and Health, 2008
Background: An HIV behavioral surveillance survey was undertaken in November 2005 at Lugufu refug... more Background: An HIV behavioral surveillance survey was undertaken in November 2005 at Lugufu refugee camp and surrounding host villages, located near western Tanzania's border with the Democratic Republic of Congo (DRC).
International Journal of …, 2009
BMC Pregnancy and Childbirth, 2012
Background: Poorly spaced pregnancies have been documented worldwide to result in adverse materna... more Background: Poorly spaced pregnancies have been documented worldwide to result in adverse maternal and child health outcomes. The World Health Organization (WHO) recommends a minimum inter-birth interval of 33 months between two consecutive live births in order to reduce the risk of adverse maternal and child health outcomes. However, birth spacing practices in many developing countries, including Tanzania, remain scantly addressed. were analyzed to investigate birth spacing practices among women of childbearing age. The outcome variable, non-adherence to the minimum inter-birth interval, constituted all inter-birth intervals <33 months long. Inter-birth intervals ≥33 months long were considered to be adherent to the recommendation. Chi-Square was used as a test of association between non-adherence and each of the explanatory variables. Factors affecting non-adherence were identified using a multilevel logistic model. Data analysis was conducted using STATA (11) statistical software.
International Journal of Gynecology & Obstetrics, 2000
While antenatal care does not directly contribute to reducing maternal mortality, it may play an ... more While antenatal care does not directly contribute to reducing maternal mortality, it may play an indirect role by encouraging women to deliver with a skilled birth attendant or in a health facility. We investigated whether the frequency of visits and select characteristics of antenatal care were associated with facility delivery. We selected a population-representative sample of households in a rural district of western Tanzania. Women who had given birth within five years were asked about their most recent delivery and antenatal care. Of 1,204 women interviewed, 1,195 (99.3%) made at least one antenatal care visit, while only 438 (36.4%) delivered in a health facility. In adjusted analysis, women were significantly more likely to deliver in a health facility if they attended antenatal care at a government health center (OR 3.17, 95% CI: 1.60-6.30) or a mission facility (OR 2.87, 95% CI: 1.36-6.07), rather than a government dispensary. Women were significantly less likely to deliver in a health facility if their nearest health facility was outside their village (OR 0.38, 95% CI: 0.22-0.66). Though facility utilization for antenatal care is frequent, most women who accessed antenatal care did not deliver in a health facility. Women who obtained antenatal care at higher level government facilities or mission facilities, which offered better quality of care, were more likely to deliver in any facility. Improving the quality of antenatal care may improve the health of mothers through encouraging women to return to facilities for delivery.
objective To identify the main drivers of costs of facility delivery and the financial consequenc... more objective To identify the main drivers of costs of facility delivery and the financial consequences for households among rural women in Tanzania, a country with a policy of delivery fee exemptions.
International Journal of …, 2009
Objective: To assess women's satisfaction with traditional birth attendants (TBAs) in rural Tanza... more Objective: To assess women's satisfaction with traditional birth attendants (TBAs) in rural Tanzania. Method: A population-representative sample of households in Kasulu district was used to collect data on demographics, childbirth history, and perception of TBAs and doctors/nurses from women who had recently had a child and from their partners. Results: Two-thirds of women who gave birth in a health facility reported being very satisfied with the experience, compared with 21.2% of women who delivered at home with TBAs. A sizeable proportion of women felt that TBAs had poor medical skills (23.1%), while only 0.3% of women felt the same about doctors' and nurses' skills. Of women who delivered with a TBA, 16.0% reported that TBAs had poor medical skills whereas 0.5% stated the same for doctors and nurses. Conclusion: Although many women delivered at home in this rural study district, women and their partners reported higher confidence in doctors and nurses than in TBAs. Policymakers and program managers should not assume that women prefer TBAs to trained professionals for delivery but should consider system barriers to facility delivery in interventions aimed at reducing maternal mortality.
BMC Public Health, 2011
Background Although some studies in Tanzania have addressed the question of sexuality and STIs am... more Background Although some studies in Tanzania have addressed the question of sexuality and STIs among adolescents, mostly those aged 15 - 19 years, evidence on how multiple sexual partners influence condom use among 10 - 19 year-olds is limited. This study attempts to bridge this gap by testing a hypothesis that sexual relationships with multiple partners in the age group 10 - 19 years spurs condom use during sex in four districts in Tanzania. Methods Secondary analysis was performed using data from the Adolescents Module of the cross-sectional household survey on Maternal, Newborn and Child Health (MNCH) that was done in Kigoma, Kilombero, Rufiji and Ulanga districts, Tanzania in 2008. A total of 612 adolescents resulting from a random sample of 1200 households participated in this study. Pearson Chi-Square was used as a test of association between multiple sexual partners and condom use. Multivariate logistic regression model was fitted to the data to assess the effect of multiple sexual partners on condom use, having adjusted for potential confounding variables. STATA (10) statistical software was used to carry out this process at 5% two-sided significance level. Results Of the 612 adolescents interviewed, 23.4% reported being sexually active and 42.0% of these reported having had multiple (> 1) sexual partners in the last 12 months. The overall prevalence of condom use among them was 39.2%. The proportion using a condom at the last sexual intercourse was higher among those who knew that they can get a condom if they want than those who did not. No evidence of association was found between multiple sexual partners and condom use (OR = 0.77, 95% CI = 0.35 - 1.67, P = 0.504). With younger adolescents (10 - 14 years) being a reference, condom use was associated with age group (15 - 19: OR = 3.69, 95% CI = 1.21 - 11.25, P = 0.022) and district of residence (Kigoma: OR = 7.45, 95% CI = 1.79 - 31.06, P = 0.006; Kilombero: OR = 8.89, 95% CI = 2.91 - 27.21, P Conclusion No evidence of association was found between multiple sexual partners and condom use among adolescents in the study area. The large proportion of adolescents who engage in sexual activity without using condoms, even those with multiple partners, perpetuates the risk of transmission of HIV infections in the community. Strategies such as sex education and easing access to and making a friendly environment for condom availability are important to address the risky sexual behaviour among adolescents.
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Papers by Godfrey Mbaruku