Outcomes of a Program to Reduce Birth-Related Mortality in Tanzania
| dc.contributor.author | Kalabamu, Florence S. | |
| dc.date.accessioned | 2026-05-15T09:36:35Z | |
| dc.date.available | 2026-05-15T09:36:35Z | |
| dc.date.issued | 2025-02-26 | |
| dc.description.abstract | Background Birth-related mortality is a major contributor to the burden of deaths worldwide, especially in low-income countries. The Safer Births Bundle of Care program is a combination of interventions developed to improve the quality of care for mother and baby with the goal of reducing birth-related mortality. Methods We performed a 3-year stepped-wedge cluster-randomized study of the Safer Births program at 30 high-burden facilities in five regions in Tanzania. The bundle of interventions in the program was aimed at continuous quality improvement through regular onsite simulation-based training, the collection and use of local clinical data, the assistance of trained local facilitators, and the use of innovative tools for perinatal care. The primary outcome was perinatal death, which included intrapartum stillbirth (suspected death during labor) and neonatal death within the first 24 hours after birth. Results A total of 281,165 mothers and 277,734 babies were included in the final analysis. The estimated incidence of perinatal death decreased from 15.3 deaths per 1000 births in the baseline period of the program to 12.5 deaths per 1000 births after implementation (adjusted relative risk, 0.82; 95% confidence interval [CI], 0.73 to 0.92; P=0.001), with substantial heterogeneity among regions. The incidence of intrapartum stillbirths was 8.6 deaths per 1000 births in the baseline period and 8.7 deaths per 1000 births after implementation (adjusted relative risk, 1.01; 95% CI, 0.87 to 1.17), and the incidence of neonatal deaths within the first 24 hours after birth was 6.4 and 3.9 deaths per 1000 births, respectively (adjusted relative risk, 0.61; 95% CI, 0.49 to 0.77). No serious adverse events were reported. Conclusions Implementation of the Safer Births Bundle of Care program showed the feasibility of integrating quality-improvement efforts targeting birth-related emergencies in resource-limited settings and was associated with a significant reduction in perinatal mortality. (Funded by the Global Financing Facility; ISRCTN Registry number, ISRCTN30541755.) Birth-related mortality is a major contributor to the burden of deaths worldwide, ranking eighth globally and third in low-income countries.1 Most stillbirths and neonatal and maternal deaths are preventable if basic quality care is provided, especially during birth, when the mother and baby share common risk factors and complications and jointly benefit from various interventions.2 In 2020, an estimated 4.5 million combined deaths occurred globally: 0.3 million maternal deaths, 2.3 million neonatal deaths, and 1.9 million stillbirths.3-5 Ten countries, including Tanzania, account for 60% of this burden.2 The World Health Organization (WHO) and the Sustainable Development Goals have specified targets regarding birth-related deaths to reach by 2030.6,7 These targets include reducing the incidence of stillbirths to at least as low as 12 deaths per 1000 births,6 the incidence of neonatal deaths to at least as low as 12 deaths per 1000 live births, and maternal deaths to lower than 70 deaths per 100,000 live births.7 In 2020, global maternal mortality was estimated to be 223 deaths per 100,000 live births.3 In 2022, the estimated global incidences of neonatal deaths and stillbirths were 17 deaths per 1000 live births and 14 deaths per 1000 births, respectively.4,5 Approximately 45% of stillbirths are related to complications that occur during the intrapartum period. Annual incidences of reduction in stillbirths and neonatal and maternal deaths are currently too slow to meet the global goals for 2030.2-5 The Safer Births Bundle of Care was created to combat birth-related mortality, with an approach that targets intrapartum stillbirths and neonatal and maternal deaths simultaneously.8,9 The bundle was developed in Tanzania, iteratively over a 10-year period, to improve the quality of care around the time of birth and consists of four main components: innovative simulation training methods and equipment, strategies for data-guided continuous quality-improvement efforts, innovative clinical devices for fetal and neonatal heart-rate monitoring, and processes to support sustainability and scalability. The Helping Babies Breathe10 (American Academy of Pediatrics) and Helping Mothers Survive Bleeding After Birth Complete, version 2.0,11 scenarios were integrated into the training component. All the innovative training and quality-improvement strategies and devices were tested separately in multiple studies before being merged into the bundle.8 In 2020, the Safer Births Bundle of Care received an Innovation-to-Scale award from the Global Financing Facility to undertake the first phase of implementation at 30 facilities in five regions with a high burden of birth-related deaths in Tanzania, involving approximately 300,000 births over a 3-year period. The primary aim of this study was to document the effect of the interventions on in-hospital perinatal mortality. | |
| dc.identifier.citation | Kamala, B.A., Ersdal, H.L., Moshiro, R.D., Guga, G., Dalen, I., Kvaløy, J.T., Bundala, F.A., Makuwani, A., Kapologwe, N.A., Mfaume, R.S. and Mduma, E.R., 2025. Outcomes of a program to reduce birth-related mortality in Tanzania. New England Journal of Medicine, 392(11), pp.1100-1110. | |
| dc.identifier.issn | DOI: 10.1056/NEJMoa2406295 | |
| dc.identifier.uri | http://kuir.ku.ac.tz:4000/handle/123456789/1557 | |
| dc.publisher | New England Journal of Medicine | |
| dc.subject | Program to Reduce Birth-Related Mortality | |
| dc.subject | Tanzania | |
| dc.title | Outcomes of a Program to Reduce Birth-Related Mortality in Tanzania | |
| dc.type | Article |