Learning from Health Care Workers’ Opinions for Improving Quality of Neonatal Health Care in Kilimanjaro Region, Northeast Tanzania

B Mbwele, NL Ide, JG Mrema, AP Ward Sarah, JA Melnick,and R Manongi
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Background: There is a higher neonatal mortality rate while the adherence to the existing guidelines is rarely studied in Tanzania. Aim: The aim of this study is to assess the performance of health workers for neonatal health-care.

Materials and Methods: Settings - Peripheral health facilities (regional referral, district hospitals and health centers) and a tertiary referral hospital of Kilimanjaro region, Tanzania. Fourteen hospital facilities within all seven districts of the Kilimanjaro region wer involved in this cross-sectional descriptive study. Data were collected for 5 months from 26th November, 2010 to 25th April, 2011. We analyzed our quantitative data by using STATA v10 (StataCorp, TX, USA) for statistical comparison using Chi-square test to test the difference between the categories and odds ratio (OR) for association between independent and dependent variables.

Results: Birth asphyxia was the most recalled health problem requiring critical care, reported by 27.5% (33/120) of health-care workers (HCWs) at peripheral hospitals and at 46.4% (13/28) in a tertiary referral centers. Majority of HCWs commented on their own performance 47.5% (67/140). In the periphery (40), first comment was on management and follow-up of neonatal cases 47.5% (19/40), second on a need of skills 45% (18/40) and third on timely referrals 7.5% (18/40). Shortage of proper equipment was reported at 26.4% (37/140), shortage of staff was reported at 12.0% (17/140), lack of organization of care 11.4% (16/140) and poor hygiene at 2.9% (4/140). It was hard to judge the impact of training on the sufficiency of knowledge (OR: 2.1; 95% confidence interval: [0.9 - 4.8]; P = 0.08) although levels of knowledge for critical neonatal care were higher at the tertiary referral hospital (Pearson χ2 [2] = 53.8; P < 0.001).

Conclusion: Performance of HCWs in early neonatal care is suboptimal and requires frequent systematic evaluation.