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Bixby Project 2004

Bixby Project 2004. Kigoma, Tanzania Andy Anglemyer, Nadia Diamond-Smith, Jessica Jeffrey. Study Overviews. Maternal Mortality in Kigoma TACARE’s Community Based Distribution (CBD) Program. Maternal Mortality in Kigoma. Kigoma is located on the eastern shores of Lake Tanganyika

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Bixby Project 2004

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  1. Bixby Project 2004 Kigoma, Tanzania Andy Anglemyer, Nadia Diamond-Smith, Jessica Jeffrey

  2. Study Overviews • Maternal Mortality in Kigoma • TACARE’s Community Based Distribution (CBD) Program

  3. Maternal Mortality in Kigoma • Kigoma is located on the eastern shores of Lake Tanganyika • Annual per capita income is $140, $80 in very rural areas • One of the four highest maternal mortality rates in the country • 300/100,000 • 490,816 residents • 25% are women between 15 and 45

  4. Regional Health Facilities • Maweni is the only public hospital in the region • 75 registered villages, spread over 11,600 km² • 4 health clinics • 54 village dispensaries

  5. Previous Interventions • Between 1984-1991 at Maweni Hospital • Health worker involvement and effective utilization of local resources • MM rate fell from 933 to 186/100,000 residents

  6. Pre-intervention survey in 1999 Considered lessons learned from previous intervention Health centers and dispensaries focal points for data collection Information collected on: Community perceptions of antenatal care, emergency OB care, FP, TBA, equipment availability for emergency OB care in peripheral health units Replication of InterventionMethods

  7. Methods (cont) • Sisterhood method used to determine maternal mortality in rural • A post-intervention survey conducted in 2003 using same methods and health units • 2 health units from each division selected (12 total selected) • Records reviewed • Individuals interviewed • 40 health workers, 20 TBA’s from 2 randomly selected villages, 480 community members

  8. Suggested Risk Factors • Lack of community education regarding maternal mortality • Gender imbalances • Knowledge of obstetric health issues --low quality of care • Transportation difficulties • 50% of villages only accessible by boat • Qualified personnel unwilling to work in remotest areas

  9. Risk Factors (cont) • Health facilities lack proper equipment • Partial supply of OB care equipment and drugs • Lack of a blood transfusion program • Results in anemia and hemorrhaging • Facilities in disrepair with lack of funding • Deficit of qualified staff

  10. Interventions • Subsidized mosquito nets • Village leaders’ meetings • Community referral funds • Transportation options • 3 ambulance cars • Subsidized boat costs • Additional health care workers in rural areas

  11. Interventions (cont) • Benefits for health care workers • Education and leave • Locals trained in maternal health • 20 TBA’s, 102 VHW’s • OB complications and specialized training • DHO flights to rural communities • New hospital equipment • Blood transfusion centers • Health facilities renovated

  12. Results • MM rate decrease using “sisterhood method” 166 to 137/100,000 • Increased referral compliance among community leaders • Increase in trained personnel • Number of health units with appropriate personnel (29%-60%) • Prenatal care sought more often • 25 in 1999, 201 in 2003

  13. Results (cont) • Deliveries by trained personnel increased • 5,823 in 1999; 7,225 in 2003 • Partographs used routinely • Increase of referrals from health units to hospital • 160 in 1999; 1,583 in 2003

  14. Referrals • Most common reasons: • Primi gravidae, multiparous • Self referrals increased • Average of 8/month in 2002; 12/month in 2003

  15. Discussion • Leading causes of maternal death • Anemia, malaria-induced and malnutrition • Long term impact expected • Self referrals • More faith in the health care system • Drawbacks • Lack of comparison group • Inconsistent data • Maternal deaths occur in villages • Rates are rough estimates

  16. Conclusion • Low-cost interventions • Potential for replication • Much can be done with little • Increased awareness and education the most significant aspect to lowering maternal mortality

  17. TACARE’s CBD Program Participating Regional Health Facilities • 4 Health Centers --IUD’s and injectables • 54 Village Dispensaries --oral contraceptives, injectables, condoms

  18. Health Centers • Usually staffed by a nurse or clinical officer • Provides basic inpatient health care

  19. Village Dispensaries • 54 total in Kigoma Region • The majority of population relies on these for FP services and health care • Patient referrals • Provide basic medications and contraceptives

  20. Family Planning Access • Contraceptives provided by funds from USAID (1970’s) and the Ministry of Health (1995) • Contraceptives available at no cost in health facilities • Contraceptive Prevalence estimated at 4%, Birth Rate 2.8% • Acceptance Rate for FP ~ 14%

  21. Accessibility Obstacles What must a CBD program overcome? • Great traveling distances • Accessible only by boat or 4WD • Work Priorities • Local religious opposition • Patriarchal society

  22. TACARE’s CBD Program • Lake Tanganyika Catchment Reforestation and Education Project --original purpose of promoting sustainable land-use practices and preserving indigenous forests • In 1999 CBD project initiated --currently 14 villages, 40 agents

  23. The Agent • Village selected • Kiswahili literate and 7 years of education • Must have a willingness to openly discuss FP topics among community • Attend 3 week training session • CBD Supervisor

  24. Services Offered • Counseling and education in family planning and sexual health --info about oral contraceptives, condoms, IUD’s, injectables, Norplant, tubal ligation, vasectomies --alternatives discussed: withdrawal, “standard days” method

  25. Services Offered (cont) • Client referrals to dispensaries • Oral contraceptives’ side effects management • STI/HIV information • Info on breastfeeding, ORT, vaccinations, and nutrition

  26. The Approach Individual Counseling --2183 sessions in 2003 Household Counseling --673 sessions in 2003 Group Counseling --134 sessions in 2003

  27. Client Preferences • Spacing births • Condoms and pills preferred • injectables seen as a plausible alternative • IUD’s considered uncomfortable • Possible stigma attached if referred • “Standard Days” method difficult

  28. Access and Restrictions • CBDA’s responsibility to motivate couples seeking services • Women given contraceptives regardless of partner’s approval • The well, market, or kids’ vaccinations • Single women have access • 15 years or older

  29. Supply Chain Central Medical Store in Kigoma(2400 km from Kigoma) Zone Medical Store in Tabora (600 km from Kigoma) District Medical Office in Kigoma Village Dispensaries in Kigoma Rural Community Based Distribution Agents in Villages

  30. Funding • Funds dried-out in 2002 • Training ceased in 2003 • FY 2004 funded by Packard Foundation and USAID • $63,486 total for FP and HIV programs

  31. CBDA Concerns • Transportation • Addressed in FY 2004 Budget • Safety • Umbrellas, flashlights, boots • Refresher courses • Restarted in FY 2004 • Other • Safe Motherhood Training, more information about malaria for children > 5

  32. CBDA Concerns (cont) • Salary • Experimental incentive program failed in 2002 • Could include compensation such as sugar or rice

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