title: Skilled birth attendants in Tanzania: a descriptive study of cadres and emergency obstetric care signal functions performed.
abstract: Although most developing countries monitor the proportion of births attended by skilled birth attendants (SBA), they lack information on the availability and performance of emergency obstetric care (EmOC) signal functions by different cadres of health care providers (HCPs). The World Health Organisation signal functions are set of key interventions that targets direct obstetric causes of maternal deaths. Seven signal functions are required for health facilities providing basic EmOC and nine for facilities providing comprehensive EmOC. Our objectives were to describe cadres of HCPs who are considered SBAs in Tanzania, the EmOC signal functions they perform and challenges associated with performance of EmOC signal functions. We conducted a cross-sectional study of HCPs offering maternity care services at eight health facilities in Moshi Urban District in northern Tanzania. A questionnaire and health facility assessment forms were used to collect information from participants and health facilities. A total of 199 HCPs working at eight health facilities in Moshi Urban District met the inclusion criteria. Out of 199, 158 participated, giving a response rate of 79.4 %. Ten cadres of HCPs were identified as conducting deliveries regardless of the level of health facilities. Most of the participants (81 %) considered themselves SBAs, although some were not considered SBAs by the Ministry of Health and Social Welfare (MOHSW). Only two out of the eight facilities provided all of the required EmOC signal functions. While Assistant Medical Officers are expected to perform all the signal functions, only 38 % and 13 % had performed vacuum extraction or caesarean sections respectively. Very few registered and enrolled nurse-midwives had performed removal of retained products (22 %) or assisted vaginal delivery (24 and 11 %). Inadequate equipment and supplies, and lack of knowledge and skills in performing EmOC were two main challenges identified by health care providers in all the level of care. In the district, gaps existed between performance of EmOC signal functions by SBAs as expected by the MOHSW and the actual performance at health facilities. All basic EmOC facilities were not fully functional. Few health care providers performed all the basic EmOC signal functions. Competency-based in-service training of providers in EmOC and provision of enabling environment could improve performance of EmOC signal functions in the district.
authors.affiliation: Liverpool School of Tropical Medicine, Liverpool, L3 5QA, UK, hleueno@liverpool.ac.uk.
authors.forename: Etsuko
authors.initials: E
authors.lastname: Ueno
authors.forename: Adetoro A
authors.initials: AA
authors.lastname: Adegoke
authors.forename: Gileard
authors.initials: G
authors.lastname: Masenga
authors.forename: Janeth
authors.initials: J
authors.lastname: Fimbo
authors.forename: Sia E
authors.initials: SE
authors.lastname: Msuya
mesh_terms: D000328:Adult; D002983:Clinical Competence / Q000706:statistics & numerical data*; D003430:Cross-Sectional Studies; D003906:Developing Countries; D004630:Emergencies; D005260:Female; D006282:Health Personnel / Q000592:standards / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D008427:Maternal Health Services / Q000592:standards / Q000706:statistics & numerical data*; D008875:Middle Aged; D008880:Midwifery / Q000592:standards / Q000706:statistics & numerical data; D009721:Nurse Midwives / Q000592:standards / Q000706:statistics & numerical data; D007744:Obstetric Labor Complications; D009774:Obstetrics / Q000379:methods / Q000592:standards / Q000706:statistics & numerical data*; D010820:Physicians / Q000706:statistics & numerical data; D011247:Pregnancy; D011787:Quality of Health Care / Q000706:statistics & numerical data*; D011795:Surveys and Questionnaires; D013636:Tanzania; D055815:Young Adult