Reproductive and Child Health Nursing

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Acquiring knowledge about the use of a newly developed electronic fetal heart rate monitor: a qualitative study among birth attendants in Tanzania
(International Journal of Environmental Research and Public Health, 2018) Mbekenga, Columba K.
In an effort to reduce newborn mortality, a newly developed strap-on electronic fetal heart rate monitor was introduced at several health facilities in Tanzania in 2015. Training sessions were organized to teach staff how to use the device in clinical settings. This study explores skilled birth attendants’ perceptions and experiences acquiring and transferring knowledge about the use of the monitor, also called Moyo. Knowledge about this learning process is crucial to further improve training programs and ensure correct, long-term use. Five Focus group discussions (FGDs) were carried out with doctors and nurse-midwives, who were using the monitor in the labor ward at two health facilities in Tanzania. The FGDs were analyzed using qualitative content analysis. The study revealed that the participants experienced the training about the device as useful but inadequate. Due to high turnover, a frequently mentioned challenge was that many of the birth attendants who were responsible for training others, were no longer working in the labor ward. Many participants expressed a need for refresher trainings, more practical exercises and more theory on labor management. The study highlights the need for frequent trainings sessions over time with focus on increasing overall knowledge in labor management to ensure correct use of the monitor over time.
Assessment of knowledge on the danger signs of pregnancy among pregnant women at Sinza Palestina Hospital in Ubungo Municipality, Tanzania
(Tanzania Journal of Health Research, 2023-09-28) Sungwa, Edson.; Mwakanyamale, Adela A.
Background: The rate of maternal mortality has dropped globally however in some developing countries the rate of decline has been slow. Several efforts have been made to improve maternal health and reduce maternal mortality. Lack of information on danger signs during pregnancy is one of the factors that contribute to maternal mortality. The study aimed to assess knowledge of pregnancy danger signs among pregnant women at Sinza Palestina Hospital in Ubungo Municipality, Tanzania. Methods: This was a cross-sectional study involving all pregnant women who attended RHC services at Sinza Palestina Hospital in Ubungo Municipality. Socio-demographic characteristics and obstetrics experiences in the last pregnancy, knowledge on danger signs of pregnancy were collected. Data were analysed using the SPSS statistical package. Categorical and continuous variables were summarized and presented in tables and bar charts. Any p-value of < 0.05, at a 95% confidence interval was regarded as statistically significant. Results: A total of 410 pregnant women aged 18 – 46 years, mean age of 27 years were enrolled in this study. Amongst, 66 (16.1%) had low knowledge on obstetric danger signs and associated with age less than 20 years (aOR = 15.3, 95% CI: 4.8 – 48.3, p–value, < 0.001), education level (aOR = 27.7, 95% CI: 5.0 – 152, p–value, < 0.001), being single (aOR = 3.5, 95% CI: 1.1 – 12.9, p–value, < 0.04), parity (aOR = 1.9, 95% CI: 1.1 – 3.4, p–value, < 0.02 and less ANC visits (aOR = 2.6, 95% CI: 1.2 – 7.0, p–value, < 0.04). Moreover, occupation which was thought to have an association with knowledge of obstetrics danger signs, the association did not reach a statistically significant with p = 0.44. Conclusions and recommendations: In general, the findings of this study, show that the vast majority (83.9%) of pregnant mothers have sufficient knowledge of obstetric danger signs. Vaginal bleeding was the most commonly mentioned obstetric danger while Convulsion and fever were mentioned less. Age and education level of pregnant women, parity and ANC visits were identified as the significant factors for knowledge of obstetric danger signs among pregnant women. We recommend that health education and behavioural change programs to continue be implemented in all health facilities to continue imparting knowledge to all pregnant mothers. Efforts should be directed towards empowering nurse midwives.
Availability, Range and Utilization of Sexual and Reproductive Health (SRH) Services for Adolescents at Kinondoni Municipality, Dar es Salaam—Tanzania
(Open Journal of Nursing, 2020-03-27) Mwandali, Bupe K.; Mwakanyamale, Adela A.
It is estimated 1.2 billion of world’s population are adolescents aged 10 - 19 years; 80% live in developing countries. Adolescents in developing countries especially Sub-Saharan Africa (SSA) face high burden of sexual and reproductive health problems. Sixteen million girls aged 15 to 19 years give birth every year of which 95% occur in low- and middle-income countries. Twenty five percent of unsafe abortions are in 15 - 19 years in Sub-Saharan Africa. Contraceptive use is low as approximately 10% of adolescents are current users. These problems can be averted if different ranges of Sexual and Reproductive Health Services for adolescent (SRHSA) are available and utilized by adolescents. In Tanzania, there is limited information addressing the availability, types and utilization pattern of sexual and re- productive health services by adolescents. This study investigates the availability, range and utilization of sexual and reproductive health services for adolescents (ASRHS) at Kinondoni Municipality, Tanzania. Method: A cross-sectional study was carried out in April to May 2013. A checklist was used to collect information on the availability and range of services offered at selected health facilities. In depth interviews conducted with incharges of Reproductive and Child Health (RCH) clinics to explore barriers for provision Of Sexual and Reproductive Health Services (SRHS) for adolescents. Adolescents were questioned using a questionnaire on utilization of SRHS and perceived barriers. Descriptive statistics were used to summarize quantitative data and content analysis for qualitative data. Results: On availability and range of adolescents’ sexual and reproductive health services, a total of 25 health facilities were surveyed. Forty four percent of the surveyed facilities did not have the adolescent sexual and reproductive health services (ASRHS). The Adolescents Sexual and Reproductive Health (ASRH) services offered differed greatly between facilities. On utilization of adolescents’ sexual and reproductive health services in total, 204 adolescents from the community were involved in this study. A third of adolescents reported to have ever used ASRH. The adolescents perceived barriers for underutilization of the services were fear of being seen at the clinics (23.3%), lack of money (18.3%), lack of privacy & confidentiality (14.2%) and unfriendly health care providers. Three barriers were perceived by health care providers in the provision of ASRHS: integration of SRHS, lack of training in relation to adolescents SRHS and attitudes of health care providers towards young people. Conclusion: About half of the health facilities did not have the SRH-services to adolescent (44%) and different ranges of services were not offered at the facilities as it was shown in the records. The results from this study show services were underu- tilized by adolescents. Training, attitudes of health care providers towards young people, & cost influenced ASRHS provision and utilization. Strategies to increase training in ASRHS for health providers including communication skills and scaling ASRH services to all primary care facilities may help to improve availability and access of services to adolescents. Keywords Adolescent, Sexual Health, Reproductive Health, Utilization, Barriers to ASRH Services, Kinondoni Municipality and Tanzania
"Barriers to timely disclosure of HIV serostatus: A qualitative study at care and treatment centers in Dar es Salaam, Tanzania."
(PloS one, 2021) Mbekenga, Columba K.
Introduction Disclosure of Human Immunodeficiency Virus (HIV) status is important to prevent the spread of HIV and maintain the health of people living with HIV, their spouses, and the com- munity. Despite the benefits of disclosure, many people living with HIV delay disclosing their status to those close to them thereby increasing the risk for disease transmission. This study aimed to determine the barriers to timely disclosure of HIV serostatus for people living with HIV in Dar es Salaam, Tanzania, and identify what motivated disclosure. Methods A qualitative descriptive study using in-depth individual interviews was conducted with10 participants attending HIV care and treatment centers in Dar es Salaam. The participants were people living with HIV who had delayed disclosing their serostatus for more than one month after diagnosis. Data was analyzed using qualitative content analysis. Results Three categories emerged from the analysis: Barriers hindering timely disclosure, motiva- tion for disclosure of serostatus, and consequences of delayed disclosure. Barriers to timely disclosure included denial of one’s status, the fear of stigmatization, fear of being separated or divorced, the need to protect loved ones, and lack of adequate knowledge about the dis- ease. Reasons that motivated disclosure included gaining social support, preventing dis- ease transmission and wanting to be at peace. Conclusion Timely disclosure is hindered by stigma because HIV is negatively perceived by the public. People living with HIV prefer not to disclose to avoid the negative consequences of disclo- sure, especially because of fear of being discriminated against and losing their social status, which plays a major role in social status in Tanzania. Trust and adequate counseling from health care workers helps prompt disclosure
A baseline mixed-methods study on postpartum care among health professionals in Tanzania
(African Journal of Midwifery and Women's Health, 2017) Mbekenga, Columba K.
Background: Globally, postpartum care (PPC) is a neglected part of maternal and neonatal health, despite 50% of maternal deaths occuring in the first weeks after childbirth. Aim: The study aimed to assess knowledge, attitudes and practices among providers of PPC in government institutions in two low-resource suburbs of Dar es Salaam: Ilala and Temeke. Methods: Health professionals (n=149) at all levels of care completed a knowledge and attitudes questionnaire. A checklist was used to observe 25 health professionals at reproductive and child health units, and 38 mothers were interviewed on exit. χ2 - and logistic regression tests were used to analyse the outcomes. Field notes were analysed qualitatively. Findings: Overall, 64% of health professionals had high knowledge and most had positive attitudes towards PPC. Level of education was found to be positively associated with positive attitudes towards PPC (OR=2.5 CI 95% 1.03–6.13). PPC consultations with mothers and newborns during the first week after childbirth were found to be few or nonexistent. Mothers who came with newborns for BCG immunisation were mostly satisfied with the services. Conclusion: Quality improvement is required at the structure and process levels of the health system in order to provide holistic PPC consultations.
Birth preparedness and complication readiness - a qualitative study among community members in rural Tanzania.
(Global health action, 2015) Mbekenga, Columba K.
Background Birth preparedness and complication readiness (BP/CR) strategies are aimed at reducing delays in seeking, reaching, and receiving care. Counselling on birth preparedness is provided during antenatal care visits. However, it is not clear why birth preparedness messages do not translate to utilisation of facility delivery. This study explores the perceptions, experiences, and challenges the community faces on BP/CR. Design A qualitative study design using Focused Group Discussions was conducted. Twelve focus group discussions were held with four separate groups: young men and women and older men and women in a rural community in Tanzania. Qualitative content analysis was used to analyse the data. Results The community members expressed a perceived need to prepare for childbirth. They were aware of the importance to attend the antenatal clinics, relied on family support for practical and financial preparations such as saving money for costs related to delivery, moving closer to the nearest hospital, and also to use traditional herbs, in favour of a positive outcome. Community recognised that pregnancy and childbirth complications are preferably treated at hospital. Facility delivery was preferred; however, certain factors including stigma on unmarried women and transportation were identified as hindering birth preparedness and hence utilisation of skilled care. Challenges were related to the consequences of poverty, though the maternal health care should be free, they perceived difficulties due to informal user fees. Conclusions This study revealed community perceptions that were in favour of using skilled care in BP/CR. However, issues related to inability to prepare in advance hinder the realisation of the intention to use skilled care. It is important to innovate how the community reinforces BP/CR, such as using insurance schemes, using community health funds, and providing information on other birth preparedness messages via community health workers.
Birth preparedness and complication readiness among women of reproductive age in Kenya and Tanzania: a community-based cross-sectional survey. BMC Pregnancy and Childbirth.
(BMC Pregnancy and Childbirth, 2020) Mbekenga, Columba K.
Background: Delayed health-seeking continues to contribute to preventable maternal and neonatal deaths in low resource countries. Some of the strategies to avoid the delay include early preparation for the birth and detection of danger signs. We aimed to assess the level of practice and factors associated with birth preparedness and complication readiness (BPCR) in Kenya and Tanzania. Methods: We conducted community-based multi-stage cross-sectional surveys in Kilifi and Kisii counties in Kenya and Mwanza region in Tanzania and included women who delivered two years preceding the survey (2016–2017). A woman who mentioned at least three out of five BPCR components was considered well-prepared. Bivariate and multivariable proportional odds model were used to determine the factors associated with the BPCR. The STROBE guidelines for cross-sectional studies informed the design and reporting of this study. Results: Only 11.4% (59/519) and 7.6% (31/409) of women were well-prepared for birth and its complications in Kenya and Tanzania, respectively, while 39.7 and 30.6% were unprepared, respectively. Level of education (primary: adjusted odds ratio (aOR): 1.59, 95% CI: 1.14–2.20, secondary: aOR: 2.24, 95% CI: 1.39–3.59), delivery within health facility (aOR: 1.63, 95% CI: 1.15–2.29), good knowledge of danger signs during pregnancy (aOR: 1.28, 95% CI: 0.80– 2.04), labour and childbirth (aOR: 1.57, 95% CI: 0.93–2.67), postpartum (aOR: 2.69, 95% CI: 1.24–5.79), and antenatal care were associated with BPCR (aOR: 1.42, 95% CI: 1.13–1.78). Conclusion: Overall, most pregnant women were not prepared for birth and its complications in Kilifi, Kisii and Mwanza region. Improving level of education, creating awareness on danger signs during preconception, pregnancy, childbirth, and postpartum period, and encouraging antenatal care and skilled birth care among women and their male partners/families are recommended strategies to promote BPCR practices and contribute to improved pregnancy outcomes in women and newborns.
The Challenges of Providing Postpartum Education in Dar es Salaam, Tanzania: Narratives of Nurse-Midwives and Obstetricians
(Qualitative Health Research, 2017) Mbekenga, Columba K.
Postpartum education can save lives of mothers and babies in developing countries, and the World Health Organization recommends all mothers receive three postpartum consultations. More information is needed to better understand how postpartum education is delivered and ultimately improves postpartum health outcomes. The purpose of this qualitative study was to examine how postpartum care was delivered in three postnatal hospital clinics in Dar es Salaam, Tanzania. Semistructured interviews with 10 nurse-midwives and three obstetricians were conducted. Feminist poststructuralism guided the research process. Postpartum education was seen to be an urgent matter; there was a lack of supportive resources and infrastructure in the hospital clinics, and nurse-midwives and obstetricians had to negotiate conflicting health and traditional discourses using various strategies. Nurse-midwives and obstetricians are well positioned to deliver life-saving postpartum education; however, improvements are required including increased number of nurse-midwives and obstetricians.
A cohort study to compare banana leaves dressing with convention dressing for children with burn wounds at Bugando Medical Centre, Mwanza, Tanzania 2021
(Tanzania journal of health research, 2023-03-26) Sungwa, Edson.; Mwakanyamale, Adela A.; Stephen, Ambroce M.
Background: Globally burns among children is a public health concern. Banana leaf dressings or Conventional dressing materials may be used to dress burn wounds to children. The study aimed to explore outcomes of burn wounds dressed using banana leaves and conventional dressing materials respectful. Methods: Hospital based cohort study design conducted at Bugando Medical Center Burn Unit. Non-probability convenient sampling method with a sample size of 35 pediatric patients with burn wounds for each group of convectional dressing methods and banana leaf dressings were reached. Stata program Version 13 was used to analyze data. Results: A total of 70 children; 1 to 18 years, median age of 4 and interquartile range [IQR: 1-17] years were enrolled in the study. Thirty-five were dressed with Banana leaf other 35 were dressed with convention materials. Results showed that Banana leaf dressing was associated with; less pain (aOR = 0.2, 95% CI: 0.1 – 0.5, p – value <0.001), less medication use (aOR = 3.0,95% CI: 1.1 – 8.7, p – value 0.02) and good satisfaction (aOR = 85.6, 95% CI: 3.3 – 219, p – value <0.001) respectful during dressing change compared to conventional dressing method. However, no different observed between length of hospital stay and dressing method chosen. Conclusions: Although there is no evidence of a dressing method that is best for burn wounds. This study shows that Banana leaf dressing is convenient in terms of having less pain experiences and that it can be locally obtained in areas where banana plant is easily available. We recommend the use of banana leaf dressings for burns moreover, enlightenment of the public on the intervention and prevention of burns among children. Keywords: Banana leaf dressing, Conventional dressing, Burns, wound
Developing an international multidisciplinary research collaboration: Lessons learned
(In APHA Meetings: Online Program, 2012) Mbekenga, Columba K.
Background: Improving global health through international research collaboration is increasingly becoming a common pathway of transferring knowledge across cultures. Developing such collaborations, however, is challenging. This presentation will discuss the ongoing process, challenges, and lessons learned for developing a multidisciplinary HIV/AIDS research partnership between American and Tanzanian universities. Process of Partnership: To date, HIV prevention programs in Tanzania have not been entirely successful, and numerous investigators have called for multidisciplinary models. For this reason, an investigator from the Wright State University (WSU) College of Nursing partnered with researchers from WSU's school of medicine and schools of nursing and public health at the Muhimbili University of Health and Allied Sciences (MUHAS) in Tanzania. Initially, two WSU investigators travelled to Tanzania in June 2011 to confer with MUHAS investigators to get support for developing a collaborative research project. The meeting resulted in a WSU-funded needs-assessment project to be conducted in Tanzania in December 2011. Observations and Conclusions: Taking a project to an international level involves practical considerations. Partnership expectations on data sharing and dissemination, leadership and authorship should be made explicit. Understanding all the steps for research approval and the ethical boards involved is also essential. Budgetary issues should be anticipated, as international research is expensive. For example, costs for the local investigators must be covered in the budget because data collection is best accomplished by local researchers, who have no local funding. Other potential barriers such as power outages, unreliable internet access, language differences, and cultural insensitivity should be considered.
Effectiveness of maternal referral system in Tanzania: a mixed method study
(Research Gate, 2022-07-15) Mbekenga, Columba K.; Bugomola,Monica A.
Background: Poor accessibility of emergency obstetric care services contributes to severe morbidity and high maternal mortality. Variations in the capacity of providing Emergency obstetric care by different levels of public health facilities highlights the fundamental role of maternal referral system. There has being no significant changes in the maternal mortality for the past 15 years despite the feasibility of interventions within the limited resources hospital settings. There is still a paucity of evidence on the effectiveness of the obstetric referral process in reducing maternal mortality. This study was conducted to determine referral reasons, referral delays and communication barriers influencing referrals of women with obstetric complications in order to evaluate the effectiveness of the maternal referral system. Methods: A descriptive cross-sectional design employing mixed methods approach was used to evaluate effectiveness of the maternal referral system. A 7 weeks prospective study was conducted at Muhimbili National Hospital. Quantitative data were collected through reviewing referral slips of 426 women referred from various health facilities due to obstetric complications in the peripartum period and admitted in the labour ward, postnatal ward, ICU and high dependant ward. Analysis was done using SPSS. Qualitative data was collected using 9 semi-structured in-depth interviews with nurse-midwives and obstetricians who were selected purposively, and data was analysed with qualitative content analysis. Results: A total of 426 records of referred women with obstetric complications were reviewed. Most documented reasons for referral were hospital based (62%), which included theatre being busy (25.1%), unavailability of blood (11.3%) and lack of equipment and inadequate supplies (10.3%). 60.3% accounted for delayed referrals. The study identified referral-receiver communication barriers which include inconsistent use of phones before referral, unsatisfactory referral form documentation and inadequate feedback mechanism. Conclusion: The study demonstrates lack of both human and non-human resources required for provision of health care services in the referring facilities. It identifies high proportion of late referrals and deficiencies in the referral process which illustrate ineffective referral system.
Essential Coaching for Every Mother Tanzania (ECEM-TZ): Protocol for a Type 1 Hybrid Effectiveness-Implementation Randomized Controlled Trial
(Journal of Medical Internet Research, 2024-12-05) Columba, Mbekenga K.
Background Despite global goals to improve maternal, newborn, and child health outcomes, mortality and morbidity continue to be a concern, particularly during the postnatal period in low- and middle-income countries. While mothers have the responsibility of providing ongoing care for newborns at home, they often receive insufficient newborn care education in Tanzania. Mobile health via text messaging is an ever-growing approach that may address this gap and provide timely education. Objective We aim to evaluate a text message intervention called Essential Coaching for Every Mother Tanzania (ECEM-TZ) to improve maternal access to essential newborn care education during the immediate 6-week postnatal period. Methods ECEM-TZ consists of standardized text messages from birth to 6 weeks post partum that provide evidence-based information on caring for their newborn and recognizing danger signs. Messages were developed and then reviewed by Tanzanian mothers and nurse midwives before implementation. A hybrid type 1 randomized controlled trial will compare ECEM-TZ to standard care among mothers (n=124) recruited from 2 hospitals in Dar es Salaam. The effectiveness outcomes include newborn care knowledge, maternal self-efficacy, breastfeeding self-efficacy, maternal mental health, attendance at the 6-week postnatal checkup, and newborn morbidity and mortality. The implementation outcomes include the reach and quality of implementation of the ECEM-TZ intervention. Results Recruitment for this study occurred between June 13, 2024, and July 22, 2024. A total of 143 participants were recruited, 71 in the control and 72 in the intervention. The 6-week follow-up data collection began on July 30, 2024, and was completed on September 21, 2024. Conclusions This study will generate evidence about the effectiveness of implementing text messaging during the early postnatal period and the feasibility of doing so in 2 hospitals in Dar es Salaam. The intervention has been designed in collaboration with mothers and nurse midwives in Tanzania. Trial Registration ClinicalTrials.gov NCT05362305; https://clinicaltrials.gov/study/NCT05362305 International Registered Report Identifier (IRRID) DERR1-10.2196/63454 Keywords: mobile health, maternal health, randomized controlled trial, parenting self-efficacy, self-efficacy, maternal, RCT, mother, text message, coaching, postnatal, newborn, child, low-income country, middle-income country, Africa, newborn care education, nurse midwife, Tanzania
Factors affecting effective ventilation during newborn resuscitation: a qualitative study among midwives in rural Tanzania
(Global Health Action, 2018) Mbekenga, Columba K.
Background: Intrapartum-related hypoxia accounts for 30% of neonatal deaths in Tanzania. This has led to the introduction and scaling-up of the Helping Babies Breathe (HBB) programme, which is a simulation-based learning programme in newborn resuscitation skills. Studies have documented ineffective ventilation of non-breathing newborns and the inability to follow the HBB algorithm among providers. Objective: This study aimed at exploring barriers and facilitators to effective bag mask ventilation, an essential component of the HBB algorithm, during actual newborn resuscitation in rural Tanzania. Methods: Eight midwives, each with more than one year’s working experience in the labour ward, were interviewed individually at Haydom Lutheran Hospital, Tanzania. The audio recordings were transcribed and translated into English and analysed using qualitative content analysis. Results: Midwives reported the ability to monitor labour properly, preparing resuscitation equipment before delivery, teamwork and frequent ventilation training as the most effective factors in improving actual ventilation practices and promoting the survival of newborns. They thought that their anxiety and fear due to stress of ventilating a non-breathing baby often led to poor resuscitation performance. Additionally, they experienced difficulties assessing the baby’s condition and providing appropriate clinical responses to initial interventions at birth; hence, further necessary actions and timely initiation of ventilation were delayed. Conclusions: Efforts should be focused on improving labour monitoring, birth preparedness and accurate assessment immediately after birth, to decrease intrapartum-related hypoxia. Midwives should be well prepared to treat a non-breathing baby through high-quality and frequent simulation training with an emphasis on teamwork training.
Factors related to attitude-associated stigma among caregivers of mentally ill patients in Tanzania.
(The Aga Khan University, 2024-10-08) Mbao, Ezekiel H.
Background: Attitude-associated stigmas towards patients with mental illness affect most patients. However, the factors related to attitude-associated stigma among caregivers remain unknown. This might lead to the disruption of family relationships, low self-esteem, lack of socialization and other adverse effects. Therefore, the current study aimed to determine the associated stigma among caregivers of a patient with a mental illness Methods: A quantitative approach, with a cross-sectional study design, was used, involving two standardized questionnaires: Community Attitudes Towards the Mentally Ill (CAMI) Scale and Modified Consumer Experiences of Stigma Questionnaire (MCESQ), which were used to measure attitudes associated with stigma towards mentally ill patients, experienced stigma and discriminations among caregivers of patient with mental illness. Data were analyzed using SPSS version 20, and descriptive and appropriate inferential statistics such as Chi-square test, Pearson correction and logistic regression were used. Results: 422 caregivers living with mentally ill people attending Mirembe National Mental Hospital participated in the study. The overall prevalence of attitude-associated stigma towards mentally ill patients among caregivers was 95.3% in all four dimensions. However, in those who experienced stigma and discrimination, the overall prevalence was 63.3%. Factors that were statistically significantly associated with experiencing stigma and discrimination against mental disorders were age, education, occupation, place of residence, relationship and frequency of admission. Conclusion: Attitudes associated with stigma towards mentally ill patients among caregivers are associated with admissions, relationships and some demographic characteristics. Thus, the current study suggests that social support should be provided to caregivers with a family member having a mental illness. However, future studies with longitudinal study design might provide the risk factors that predispose caregivers to attitude-associated stigma.
Factors shaping good and poor nurse-client relationships in maternal and child care in rural Tanzania
(Research squire, 2022-09-05) Mbekenga, Columba K.
Background Evidence indicates that poor nurse-client relationships within maternal and child health ( Methods Qualitative descriptive design was employed. About 9 Focus Group Discussions ( Results Factors shaping nurse-client relationships were heuristically categorized into nurse, client and health system factors. Nurse contributors of poor relationship ranged from poor reception and hospitality, not expressing care and concern, poor communication and negative attitudes, poor quality of services, job dissatisfaction and unstable mental health. Client contributors of poor relationship include being ‘much know’, late attendance, non-adherence to procedures and instructions, negative attitudes, poor communication, inadequate education and awareness, poverty, dissatisfaction with care, faith in traditional healers and unstable mental health. Health system contributors were inadequate resources, poor management practices, inadequate policy implementation and absence of an independent department or agency for gathering and management of complaints. Suggestions for improving nurse-client relationship included awards and recognition of good nurses, improving complaints mechanisms, continued professional development, peer to peer learning and mentorship, education and sensitization to clients, improving service quality and working conditions, improving renumeration and incentives, strengthening nursing school’s student screening and nursing curriculum and improving mental health for both nurses and clients. Conclusions The factors shaping poor nurse- client relationships appear to extend beyond nurses to both clients and healthcare facilities and system. Implementation of effective interventions for addressing identified factors considering feasibility and acceptance to both nurses and clients using novel strategies such as HCD could pave the way for employing good nurse-client relationships as a tool for improving performance indicators and health outcomes within MCH care.
Fear of childbirth and depressive symptoms among pregnant women: a cross-sectional survey in Tanzania
(Research Square, 2021) Mbekenga, Columba K.
Background: Many women experience fear of childbirth (FoB) and depressive symptoms (DS) during pregnancy, but little is known about FoB among Tanzanian women. The current study aimed to assess the prevalence of FoB and DS among pregnant women and determine predictors of each and both, focusing on sociodemographic and obstetric predictors. Methods: A cross-sectional study was conducted at six health facilities in two districts in Tanzania between 2018 and 2019. In total, 694 pregnant women with gestational age between 32 and 40 weeks and expecting vaginal delivery were consecutively recruited and assessed for FoB and DS. We collected data through interviews using the Wijma Delivery Expectancy Questionnaire Version A and Edinburgh Postnatal Depression Scale. We performed multivariable logistic regression to investigate the predictors of FoB and DS. Results: The prevalence rates of FoB and DS among pregnant women were 15.1% and 17.7%, respectively. FoB and DS were more likely in women aged above 30 years (AOR 6.29, 95% CI 1.43–27.84) and in single mothers (AOR 2.57, 95% CI 1.14–5.78). Women with secondary education and above and those who had given birth previously were less likely to have FoB (AOR 0.22, 95%CI 0.05–0.99) and DS (AOR 0.27, 95% CI 0.01–0.87). Women who had previous obstetric complications, and those who did not receive any social support from male partners in previous childbirth were more likely to have FoB and DS. FoB was strongly associated with DS (AOR 3.42, 95% CI 21.20–5.53). DS only was more common in women who had inadequate income (AOR 2.35, 95% CI 1.38–3.99) or had previously experienced a perineal tear (AOR 2.32, 95% CI 1.31–4.08). Conclusions: Not having a formal education, having only primary education, being aged above 30 years, being single, being nulliparous, having experienced obstetric complications, and having a lack of social support from a male partner during previous pregnancy and childbirth were predictors of FoB and DS during pregnancy. FoB and DS were strongly associated with each other. It is vital to identify at-risk women early, to offer support during pregnancy and childbirth
Fear of Childbirth: Validation of the Kiswahili Version of Wijma Delivery Expectancy/Experience Questionnaire Version A&B in Tanzania
(BMC Pregnancy and Childbirth, 2022) Mbekenga, Columba K.
Abstract Background: Fear of childbirth is common both before and after childbirth, often leading to complications in mother and new-born. The Wijma Delivery Expectancy/Experience Questionnaires (W-DEQ) are commonly used to measure fear of childbirth among women before (version A) and after childbirth (version B). The tools are not yet validated in the Tanzanian context. This study aimed to validate the reliability, validity, and factorial structure of their Kiswahili translations. Methods: A longitudinal study was conducted in six public health facilities in the Pwani region, Tanzania. In all, 694 pregnant and 625 postnatal women were concurrently selected and responded to W-DEQ-A and W-DEQ-B. Validation involved: translating the English questionnaires into Kiswahili; expert rating of the relevancy of the Kiswahili versions’ items; computing content validity ratio; piloting the tools; data collection; statistical analysis with reliability evaluated using Cronbach’s alpha and the intraclass correlation coefficient. Tool validity was assessed using factor analysis, con- vergent and discriminant validity. Exploratory factor analysis and confirmatory factor analysis were conducted on data collected using W-DEQ-A and W-DEQ-B, respectively. Results: Exploratory factor analysis revealed seven factors contributing to 50% of the total variation. Four items did not load to any factor and were deleted. The factors identified were: fear; lack of self-efficacy; lack of positive anticipa- tion; isolation; concerns for the baby; negative emotions; lack of positive behaviour. The factors correlated differently with each other and with the total scores. Both Kiswahili versions with 33 items had good internal consistency, with Cronbach’s alphas of .83 and .85, respectively. The concerns for the baby factor showed both convergent and discrimi- nant validity. The other six factors showed some problems with convergent validity. The final model from the con- firmatory factor analysis yielded 29 items with good psychometric properties (χ2 /df = 2.26, p = < .001, RMSEA = .045, CFI = .90 and TLI = .81) Conclusions: The Kiswahili W-DEQ-A-Revised and W-DEQ-B-Revised are reliable tools and measure fear of childbirth with a multifactorial structure, encompassing seven factors with 29 items. They are recommended for measuring fear of childbirth among pregnant and postnatal Tanzanian women. Further studies are needed to address the inconsist- ent convergent validity in the revised versions and assess the psychometric properties of W-DEQ-A among pregnant women across gestational ages. Keywords: Fear of childbirth, Pregnancy, Postnatal, W-DEQ, Validity, Reliability, Tanzania
Fear, blame and transparency: Obstetric caregivers' rationales for high caesarean section rates in a low-resource setting
(Social Science & Medicine, 2015) Mbekenga, Columba K.
In recent decades, there has been growing attention to the overuse of caesarean section (CS) globally. In light of a high CS rate at a university hospital in Tanzania, we aimed to explore obstetric caregivers' rationales for their hospital's CS rate to identify factors that might cause CS overuse. After participant observations, we performed 22 semi-structured individual in-depth interviews and 2 focus group discussions with 5–6 caregivers in each. Respondents were consultants, specialists, residents, and midwives. The study relied on a framework of naturalistic inquiry and we analyzed data using thematic analysis. As a conceptual framework, we situated our findings in the discussion of how transparency and auditing can induce behavioral change and have unintended effects. Caregivers had divergent opinions on whether the hospital's CS rate was a problem or not, but most thought that there was an overuse of CS. All caregivers rationalized the high CS rate by referring to circumstances outside their control. In private practice, some stated they were affected by the economic compensation for CS, while others argued that unnecessary CSs were due to maternal demand. Residents often missed support from their senior colleagues when making decisions, and felt that midwives pushed them to perform CSs. Many caregivers stated that their fear of blame from colleagues and management in case of poor outcomes made them advocate for, or perform, CSs on doubtful indications. In order to lower CS rates, caregivers must acknowledge their roles as decision-makers, and strive to minimize unnecessary CSs. Although auditing and transparency are important to improve patient safety, they must be used with sensitivity regarding any unintended or counterproductive effects they might have.
The future of higher education and its place in society through the prism of health and allied sciences
(International Association of Universities (IAU), 2022-10) Mbekenga, Columba K.; Mashalla, Yohana J.
States regard universities as national think tanks providing strategic leadership in new knowledge generation and developing innovative solutions to societal problems. Institutional objectives of any university include teaching, research and service to society. Universities are thus central for the advancement of knowledge, generation and development of human capital, and innovations aimed at solving societal challenges and sustainable development. In a fast-changing world due to population growth, technological transformations, emerging and re-emerging diseases and increased mobility, the key challenge to universities is how to remain relevant in meeting societal expectations. The article highlights key challenges experienced by higher education institutions (HEIs), especially in health education, and proposes strategies that would help transform HE institutions in LICs for the future.
Global Collaboration Between Tanzania and Japan to Advance Midwifery Profession: A case report of Partnership Model.
(Journal of Nursing Education and Practice, 2015) Mbekenga, Columba K.
The global health agenda to reduce maternal mortality is delayed in Sub-Saharan Africa. The shortage of skilled birth attendants in Tanzania hinders the improvement of midwifery care to prevent maternal mortality and morbidity. It is urgently neccesary to develop midwifery leaders capable of working as educators, researchers, administrators, and advanced practitioners, contributing to the improvement of midwifery care and maternal child health in their own country. This report describes the process of establishing the first midwifery master’s program in Tanzania through the efforts of two academic institutions, one in Tanzania and one in Japan. The collaboration developed a sustainable partnership model for the advancement of midwifery education. This partnership model was based upon the professional relationships corresponding with our values of humanized childbirth and people-centered care. The key elements for the project success included: (1) spending adequate time for in-person communication with the collaborative partner; (2) sharing the same goals and concepts; (3) understanding different values and norms for working and living; (4) learning ways of communication and project implementation in the partner’s culture and (5) confirming the feasibility, which could increase team members’ motivation and commitment. Midwives from the two institutions both gained knowledge and research outcomes as well as the satisfaction of establishing the midwifery master’s program. To improve the remaining global maternal health issues, this win-win collaboration should be considered as the 21st century’s partnership model for the global health community

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