title: Learning from health care workers' opinions for improving quality of neonatal health care in kilimanjaro region, northeast Tanzania.
abstract: BACKGROUND
  There is a higher neonatal mortality rate while the adherence to the existing guidelines is rarely studied in Tanzania.
  
  
  OBJECTIVE
  The aim of this study is to assess the performance of health workers for neonatal health-care.
  
  
  METHODS
  Settings - Peripheral health facilities (regional referral, district hospitals and health centers) and a tertiary referral hospital of Kilimanjaro region, Tanzania. Fourteen hospital facilities within all seven districts of the Kilimanjaro region wer involved in this cross-sectional descriptive study. Data were collected for 5 months from 26(th) November, 2010 to 25(th) April, 2011. We analyzed our quantitative data by using STATA v10 (StataCorp, TX, USA) for statistical comparison using Chi-square test to test the difference between the categories and odds ratio (OR) for association between independent and dependent variables.
  
  
  RESULTS
  Birth asphyxia was the most recalled health problem requiring critical care, reported by 27.5% (33/120) of health-care workers (HCWs) at peripheral hospitals and at 46.4% (13/28) in a tertiary referral centers. Majority of HCWs commented on their own performance 47.5% (67/140). In the periphery (40), first comment was on management and follow-up of neonatal cases 47.5% (19/40), second on a need of skills 45% (18/40) and third on timely referrals 7.5% (18/40). Shortage of proper equipment was reported at 26.4% (37/140), shortage of staff was reported at 12.0% (17/140), lack of organization of care 11.4% (16/140) and poor hygiene at 2.9% (4/140). It was hard to judge the impact of training on the sufficiency of knowledge (OR: 2.1; 95% confidence interval: [0.9 - 4.8]; P = 0.08) although levels of knowledge for critical neonatal care were higher at the tertiary referral hospital (Pearson χ(2) [2] = 53.8; P < 0.001).
  
  
  CONCLUSIONS
  Performance of HCWs in early neonatal care is suboptimal and requires frequent systematic evaluation.
authors.affiliation: Kilimanjaro Clinical Research Institute, P.O Box 2236, Moshi, Tanzania.
authors.forename: B
authors.initials: B
authors.lastname: Mbwele
authors.affiliation: Global Health, University of Washington, Seattle, Washington, USA.
authors.forename: Nl
authors.initials: N
authors.lastname: Ide
authors.affiliation: Kilimanjaro Clinical Research Institute, P.O Box 2236, Moshi, Tanzania.
authors.forename: Jg
authors.initials: J
authors.lastname: Mrema
authors.affiliation: MD Candidate, Tufts University School of Medicine, 145 Harrison Avenue, Boston, MA 02111, USA.
authors.forename: Ap
authors.initials: A
authors.lastname: Ward Sarah
authors.affiliation: Cellular Biology, Franklin College of Arts and Sciences, University of Georgia, Athens, Georgia, USA.
authors.forename: Ja
authors.initials: J
authors.lastname: Melnick
authors.affiliation: Community Health Department, Kilimanjaro Christian Medical University College, P.O Box 2240, Moshi, Tanzania.
authors.forename: R
authors.initials: R
authors.lastname: Manongi
keywords: Health care workers; Kilimanjaro; Knowledge; Neonatal; Northern Tanzania; Performance; Peripheral hospitals; Quality of care