Milken Institute School of Public Health Poster Presentations (Marvin Center & Video)

Title

Health System Determinants of Maternal Mortality in Tanzania: An analysis of regional disparities in health system capacity and its impact on maternal mortality in Tanzania.

Poster Number

76

Document Type

Poster

Status

Graduate Student - Masters

Abstract Category

Global Health

Keywords

Maternal Mortality; Tanzania, health system readiness; Basic emergency obstetric care (BEmOC)

Publication Date

4-2017

Abstract

Introduction: The Government of Tanzania has made a commitment to reduce the maternal mortality ratio (MMR) in Tanzania from 410 deaths per 100,000 live births in 2015, to 292 by 2020. This target is based on raising the percentage of facility-assisted deliveries and improving access to and quality of emergency obstetric care at the dispensary and health center level (MOHSW, 2015). Census data from 2012 show great regional disparity in MMR with the highest and lowest regions differing by a factor of 5. This cross-sectional study investigates whether regional health systems capacity contributes to the variability in regional MMR.

Methods: The study uses regression analysis to correlate regional health system usage and quality factors identified in the Service Provision Assessment (SPA) and Demographic and Health Survey (DHS), both from 2015, with sub-national maternal mortality data collected in Tanzania's thirty administrative regions during the 2012 Household and Population Census. Health system factors included quality variables for dispensary and health center readiness to deliver basic emergency obstetric care (BEmOC), which were created based on fifty-six factors taken from the SPA. Socio-economic and variables related to service access barriers from the DHS were included to isolate the partial contribution of health system factors to variability in regional MMR.

Results: Facility-assisted Delivery was the health system factor most highly correlated with MMR, but not with a linear relationship. In fact, the direction of the correlation only becomes negative after facility-assisted delivery reaches 65% coverage. (p=0.001) the factor most significantly correlated to higher levels of coverage of facility-assisted delivery was contraceptive prevalence (mCPR) (p=0.000). Dispensary readiness was also a contributor to facility-assisted delivery (p=0.001), even when controlling for maternal education.

Conclusions: Facility-assisted delivery is a critical path to achieving targeted reductions in MMR; however, drivers of increased facility-assisted delivery are not only the readiness of facilities to provide quality BEmOC, but reducing the burden on facilities and physical risk factors for women by increasing the use of modern contraception. While the findings from this study support the strategic priorities of Tanzania's One Plan II, an impact on MMR cannot be expected until all regions of the country achieve a 65% level of facility-assisted delivery. This will likely require regionally specific strategic plans to increase mCPR and dispensary readiness.

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Open Access

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Poster to be presented at GW Annual Research Days 2017.

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Health System Determinants of Maternal Mortality in Tanzania: An analysis of regional disparities in health system capacity and its impact on maternal mortality in Tanzania.

Introduction: The Government of Tanzania has made a commitment to reduce the maternal mortality ratio (MMR) in Tanzania from 410 deaths per 100,000 live births in 2015, to 292 by 2020. This target is based on raising the percentage of facility-assisted deliveries and improving access to and quality of emergency obstetric care at the dispensary and health center level (MOHSW, 2015). Census data from 2012 show great regional disparity in MMR with the highest and lowest regions differing by a factor of 5. This cross-sectional study investigates whether regional health systems capacity contributes to the variability in regional MMR.

Methods: The study uses regression analysis to correlate regional health system usage and quality factors identified in the Service Provision Assessment (SPA) and Demographic and Health Survey (DHS), both from 2015, with sub-national maternal mortality data collected in Tanzania's thirty administrative regions during the 2012 Household and Population Census. Health system factors included quality variables for dispensary and health center readiness to deliver basic emergency obstetric care (BEmOC), which were created based on fifty-six factors taken from the SPA. Socio-economic and variables related to service access barriers from the DHS were included to isolate the partial contribution of health system factors to variability in regional MMR.

Results: Facility-assisted Delivery was the health system factor most highly correlated with MMR, but not with a linear relationship. In fact, the direction of the correlation only becomes negative after facility-assisted delivery reaches 65% coverage. (p=0.001) the factor most significantly correlated to higher levels of coverage of facility-assisted delivery was contraceptive prevalence (mCPR) (p=0.000). Dispensary readiness was also a contributor to facility-assisted delivery (p=0.001), even when controlling for maternal education.

Conclusions: Facility-assisted delivery is a critical path to achieving targeted reductions in MMR; however, drivers of increased facility-assisted delivery are not only the readiness of facilities to provide quality BEmOC, but reducing the burden on facilities and physical risk factors for women by increasing the use of modern contraception. While the findings from this study support the strategic priorities of Tanzania's One Plan II, an impact on MMR cannot be expected until all regions of the country achieve a 65% level of facility-assisted delivery. This will likely require regionally specific strategic plans to increase mCPR and dispensary readiness.