University of Groningen Improving access to quality maternal and newborn care in low-resource settings: the case of Tanzania Bishanga, Dunstan Raphael

University of Groningen

Improving access to quality maternal and newborn care in low-resource settings: the case of

Tanzania

Bishanga, Dunstan Raphael

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2019

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Bishanga, D. R. (2019). Improving access to quality maternal and newborn care in low-resource settings:

the case of Tanzania. University of Groningen.

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Improving access to

quality maternal and

newborn care in

low-resource settings: the

case of Tanzania

ISBN: 978-94-034-1682-3 (printed version) ISBN: 978-94-034-1681-6 (electronic version) Dunstan R. Bishanga

Improving access to quality maternal and newborn care in low- resource settings: the case of Tanzania.

Doctoral Dissertation, University of Groningen, the Netherlands

© D.R. Bishanga, 2019.

All rights reserved. No part of the material protected by this copy-right notice may be reproduced or utilized in any form by any means, electronic or mechanical, including photocopying, recording, or by any information storage and retrieval system, without the prior permission of the author.

Layout and Cover design: D.R. Bishanga & Annelie Fouquet Photo Credits: Zacharia Mlacha, Jhpiego/Tanzania & Frank Kimaro, Jhpiego/Tanzania

Improving access to quality

maternal and newborn care in

low-resource settings: the case of

Tanzania

Phd thesis

to obtain the degree of PhD at the University of Groningen

on the authority of the Rector Magnificus prof. E. Sterken

and in accordance with the decision by the College of Deans. This thesis will be defended in public on

Tuesday 25 June 2019 at 11.00 hours

by

Dunstan Raphael Bishanga

Supervisor

Co-supervisors

Assessment Committee

Prof. D.E. Grobbee Prof. J.J.M. van Roosmalen

Table of Contents

List of Abbreviations 2

Chapter 1: 3

General Introduction

Chapter 2: 15

Improvement in the active management of the third stage of labor for the prevention of postpartum hemorrhage in Tanzania: a cross-sectional study

Chapter 3: 27

Tracking facility-based perinatal deaths in Tanzania: results from an indicator validation assessment

Chapter 4: 47

Structured on-the-job training to improve retention of newborn resuscitation skills: a national cohort Helping Babies Breathe study in Tanzania

Chapter 5: 57

Factors associated with institutional delivery: Findings from a cross-sectional study in Mara and Kagera Regions in Tanzania

Chapter 6: 75

Women’s experience of facility-based childbirth care and receipt of an early postnatal check for herself and her newborn in northwestern Tanzania.

Chapter 7: 93

From training to workflow: a mixed methods assessment of integration of Doppler into maternity ward triage and admission in Tanzania

Chapter 8: 121 General Discussion Summary 137 Samenvatting 141 Muhtasari 145 Acknowledgements 149 CV of the Author 151

Research Institute SHARE 155

2

List of Abbreviations

ANC antenatal care

BEmONC basic emergency obstetric and newborn care CHW community health worker

CIFF Children’s Investment Fund Foundation CPD continuing professional development FPM facility perinatal mortality

FYDP 5-Year Development Plan HBB Helping Babies Breathe HSSP Health Sector Strategic Plan KPI key performance indicator LMICs low- and middle-income countries

MAISHA Mothers and Infants Safe, Healthy Alive program MCSP Maternal and Child Survival Program

MDGs Millennium Development Goals

MMAM Mpango wa Maendeleo ya Afya ya Msingi (Primary Health Care Service Development Programme) MMR maternal mortality ratio

MOH Ministry of Health

MoHSW Ministry of Health and Social Welfare

MoHCDGE Ministry of Health, Community Development, Gender, Elderly and Children NGO non-governmental organization

NMR neonatal mortality rate NNS National Nutrition Strategy

NSGRP National Strategy for Growth and Reduction of Poverty (also known as MKUKUTA II) OJT on-the-job training

PPH postpartum hemorrhage

PO-RALG President’s Office-Regional Administration and Local Government QIT quality improvement team

SDGs Sustainable Development Goals TDHS Tanzania Demographic and Health Survey

TDHS-MIS Tanzania Demographic and Health Survey and Malaria Indicator Survey UN United Nations

USAID United States Agency for International Development WHO World Health Organization