Institutionalization of Quality of Care in Health Facilities Improves Management of Malaria in Pregnancy in Tanzania

Jasmine W. Chadewa and Rita Mutayoba of Jhpiego’s Dar es Salaam, Tanzania, office are presenting a poster at the 64th ASTMH Annual Meeting in Philadelphia at noon on Tuesday 27th October 2015. Please stop by Poster 680 and discuss the results as presented in the Abstract below.

IPTp picture aidMalaria in Pregnancy (MiP) is one of the contributors to maternal mortality in Tanzania which persists at a ratio of 410/100,000 live births. Tanzania implements WHO’s three-pronged approach to prevent MiP (use of insecticide treated bednets (ITNs), intermittent preventive treatment (IPTp) with sulfadoxine-pyrimethamine (SP) and prompt diagnosis and treatment).

Efforts are ongoing to improve IPTp and ITN coverage which is 33% and 75%, respectively. Jhpiego, in collaboration with the Ministry of Health and Social Welfare, worked in 251 health facilities to improve the quality of maternal and neonatal health by building the capacity of health care providers through training, supportive supervision, mentoring and coaching. A total of 7,181 providers and 400 tutors were trained on MiP prevention and treatment.

A quality of care study used the same methodology and sampling approach in 2010 and 2012, combining observations of women during antenatal care, inventory and record review as well as health worker knowledge. A team of MNH experts underwent clinical updates, training and orientation to the study tools.

mother & child TanzaniaData collection teams visited facilities, made observations and entered data into smart phones. The study was conducted in 12 regional hospitals and 38 lower level facilities in 12 regions including Zanzibar with a total of 391 and 366 ANC observations made in 2010 and 2012, respectively.

Between 2010 and 2012, the percentage of women receiving an ITN increased by 26% (p value = <0.0001). The change observed was due to a 33% increase in offering ITN vouchers at health centers and dispensaries. A slight improvement was seen in provision of IPTp(SP) from 62% in 2010 to 65% in 2012.

In Tanzania, application of the quality improvement approach contributed to improving MiP services. Moving forward, there is a need for the Ministry to continue strengthening ANC with effective monitoring and routine supervision to increase coverage of MiP prevention. Districts management teams and facilities need to ensure availability of SP and provide regular technical updates on the national service standards including counseling at ANC and birth preparedness.

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