KAIRUKI UNIVERSITY REPOSITORY

Welcome to Kairuki University Institutional Repository (KUIR), an open-access digital archive managed by Kairuki University Library. We collect, organize, preserve, showcase, and share digital materials created by Kairuki University scholarly community. Our goal is to offer free access to academic works for researchers and the general public:

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Predictors of early newborn deaths at Dar es Salaam public regional referral hospitals: A prospective observational hospital-based study
(PLOS one, 2025-12-11) Mhando, Grace F.; Kalabamu, Florence S.; Fataki, Maulidi R.; Galabawa, Christina C.
Newborn deaths are still a concern to global health systems. Increased rates of documented hospital-based births are incongruent to newborn survival chances worldwide. Factors for that rather paradoxical observation are largely unknown. We aimed to assess predictors of early newborn deaths at representative metropolitan referral health facilities in Africa. Materials & methods We designed a prospective, analytical, hospital-based study in neonatal units at Dar es Salaam public regional referral hospitals, Tanzania. Neonates who died within the first 7 days of life were the target population. A pre-designed Case Report Form was the main tool for data collection. Multivariable binary logistic regression model was fitted to account for predictors of early newborn deaths after appropriate linear model validation. Proportion of early newborn deaths was the outcome variable. Results We recruited and analysed 2212 neonate-days of follow-up. Prevalence of early newborn deaths was 28.1%. Birth asphyxia (χ2 = 20.4, df = 1), preterm delivery (χ2 = 5.36, df = 1) and respiratory distress syndrome (χ2 = 30.94, df = 1) were associated with early neonatal outcomes. Predictors of early newborn deaths were neonatal respiratory rate (Tachypnoea – A.O.R.: 2.28 (95% CI.: 1.44–5.79); Bradypnoea – A.O.R.: 1.9 (95% C.I.: 1.02–12.3) and gestational age (Preterm delivery – A.O.R.: 1.48, 95% CI.: 1.11–2.09 and Post-term delivery – A.O.R.: 5.05, 95% C.I.: 4.49–32.0). Conclusions Early newborn deaths rate was relatively high in this study population. Newborns’ respiratory rates and gestational age at delivery were significant clinical factors associated with early newborn deaths in this study.
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Is harmonisation of curriculum enough to ensure clinical competencies of graduates? Experience of faculty and students from two health training institutions in Tanzania: a qualitative study
(BMJ open, 2025-11-11) Moshi, Mainen J.
Objective The growing complexity of global health issues underscores the need for a skilled workforce, achievable through competency-based training (competency-based curricula, CBC) that integrates knowledge and practice. Starting from 2022, medical and nursing CBC were harmonised across universities in Tanzania to ensure all graduates attain nationally defined core competencies. The reform aligned programme structure, learning outcomes and assessment methods to promote consistency and interprofessional collaboration. However, questions remain about whether harmonisation alone can ensure the development of practical clinical competencies among students. This study explored the experiences of medical and nursing faculty and students in implementing clinical training as a component of CBC in two health training institutions in Tanzania. Design An exploratory qualitative case study was conducted with 67 participants, using 8 in-depth interviews with administrators and 8 focus group discussions with faculty and students. Data were analysed using Braun and Clarke’s thematic approach. Setting Two private, faith-based medical universities in the United Republic of Tanzania. Participants The study purposefully recruited a total of 67 participants. The participants included university administrators (including Deputy Vice Chancellors for Academics, quality assurance officers and deans), medical and nursing faculty and students (fourth-year medical and third-year nursing students). Results Two main themes emerged: challenges in implementing clinical training and strategies used to enforce clinical training. Key challenges included curriculum design gaps, inadequate faculty and clinical instructors, a large number of students and a shortage of hospital staff. Strategies used were utilisation of clinical skills and simulation laboratories, involvement of non-academic clinical specialists’ staff, use of student-centred learning methodologies and leveraging regional, district and specialised private hospitals for clinical teaching. Conclusions Despite notable challenges in clinical training, the institutions in this study have implemented proactive strategies to support clinical training. Based on the findings, stakeholders should invest in increasing faculty and clinical instructors and expanding clinical placements to regional, district and private hospitals
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Born from crisis: the evolution of interRAI and its relevance to today’s healthcare challenges
(SAGE Publications, 2025-10-27) Mashalla, Yohana J.
Fragmented healthcare systems worldwide struggle to support patient populations with complex health and social needs. System integration requires a standardized clinical health information system to better care for these populations. This review describes how interRAI systems evolved into powerful solutions to support healthcare system integration. In response to a care quality crisis in long-term care homes in the United States, Congress mandated a standardized Minimum Data Set (MDS) from which multiple outputs were derived to support care planning, care quality, and case-mix assessment. This work drew international attention, leading to the creation of interRAI. Three decades of extensive international research, stakeholder engagement, and implementation have led to the creation of comprehensive cross-sectoral assessment systems for diverse populations, including older adults, mental health patients, and children and youth. The interRAI assessment systems, widely used in Canada and internationally, constitute comprehensive clinical assessment systems capable of supporting health system integration.
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Frequency of team simulation and reduction in maternal deaths following Safer Births Bundle of Care implementation—a prospective observational study
(Advances in Simulation, 2025-11-14) Kalabamu, Florence S.
Background Safer Births Bundle of Care (SBBC) is a continuous quality improvement (CQI) program, implemented in 30 facilities in Tanzania, resulting in a 75% reduction in maternal deaths. Simulation training was introduced as a component of the CQI efforts, targeting individual and team skills, focusing on identified clinical needs. Objective The aim of this study was to describe the frequency of documented simulation sessions and the number of recurrent participants and associations with changes in maternal death. Methods SBBC was a stepped-wedge cluster randomised implementation study in 30 facilities in 5 regions of Tanzania from 2020 through 2023. The SimBegin® facilitator training program was introduced to train facilitators and support implementation of a training cascade. Fifteen selected healthcare workers were trained in three levels of SimBegin® to become facilitators (level 1) and mentors (level 2). Eight were trained to become instructors (level 3). In total, 90 local facilitators were trained to review local clinical data, run simulation sessions, and document in logbooks. Clinical data were collected from patient files by independent data collectors and looped back to the facilities on a weekly basis. Training interventions were planned, conducted, and evaluated based on identified gaps. Output measures were the frequency of simulation sessions, the number of recurring participants, and maternal death within 7 days postpartum the following month. Results Overall, 281,165 parturient women were included in this study. The SBBC implementation period was 24–32 months, and 1280 simulation sessions were documented. Maternal deaths declined from 240/100,000 births in the baseline to 60/100,000 after the start of SBBC. There was an association between the frequency of simulation sessions and the reduction in maternal deaths (23% reduction per each unit increase on the log scale, P = 0.0018), and between the number of recurring participants and the reduction in maternal deaths (16% reduction per each unit increase on the log scale, P = 0.0006). Conclusion This study documents a significant and clinically relevant association between the frequency of and participation in simulation sessions and the reduction of maternal deaths the following month.