TITLE:
Impact of Facility Delivery Intensity on the Practice of Active Management of Third Stage of Labour and Other Labour and Delivery Interventions in Tanzania
AUTHORS:
Hilda Kanama, Projestine Muganyizi
KEYWORDS:
Active Management, Third Stage, Delivery Intensity, Hemorrhage, Tanzania
JOURNAL NAME:
Open Journal of Obstetrics and Gynecology,
Vol.9 No.5,
May
27,
2019
ABSTRACT: Background: Postpartum haemorrhage (PPH)
is the leading cause of maternal mortality globally and Tanzania particularly.
The World Health Organisation recommends Active Management of Third Stage of
Labour (AMTSL) in preventing PPH, but its correct implementation has generally
remained low. Many factors have been associated with the low practice of AMTSL, but the literature on the impact of delivery
intensity is scanty. The aim was to determine the impact of facility delivery
intensity on correct practice of AMTSL and provision of other labour and
delivery interventions. Methods: In 2016, an analytical cross-section study was conducted in
four public health facilities in Dar es Salaam. A priori criterion was set at
10 daily deliveries or more for High Delivery Intensity Facilities (HDIFs) in
contrast to Low Delivery Intensity Facilities (LDIFs). All public obstetric
care hospitals and health centres were ranked such that one facility with the
highest deliveries and one with the lowest deliveries per category were
selected. All eligible deliveries between 8.00 am and 2.00 pm were studied. An
observer was assigned to each facility to time and document delivery and third
stage events. Data were entered and analysed using SPSS program version 20.
Pearson Chi square test was used for categorical data and Student’s t-test for
comparing continuous data. Clinical relevance of the differences was evaluated
by using 95% confidence intervals. Statistics with p-value
The
study was ethically approved by MUHAS Senate Research and Publication
Committee. Results: In total, 752 normal deliveries were
observed including 376 in LDIFs and 376 in HDIFs. Socio-demographic
characteristics of women were comparable in both, except that women with
secondary or higher education were more delivered in LDIFs (60.4%) than in
HDIFs (35.1%), p Conclusions: Facility delivery intensity has remarkable impact on correct practice of AMTSL,
labor and intra-partum care. Efforts to reduce maternal deaths should minimize
facility delivery intensity.