ArticleGlobal health, science and practice2022
A Comprehensive Approach to Improving Emergency Obstetric and Newborn Care in Kigoma, Tanzania.
Article in Global health, science and practice, 2022. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 17 papers, 2 of them syntheses that pooled it.
What it found
Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.
The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.
Who cites it
17 citing papers in PubMed, 2 syntheses or guidelines pooled it.
- The Effectiveness of Regionalization of Perinatal Care and Specific Facility-Based Interventions: A Systematic Review.Neonatology · 2025Pooled it
- Maternal satisfaction with emergency obstetric and newborn care services in Ethiopia and the associated factors: A systematic review and meta-analysis.Women's health (London, England)Pooled it
- Assessing basic Emergency Obstetric and Neonatal Care (BEmONC) service provision in community health centers: a mixed-methods study from Jember, Indonesia.BMC health services research · 2026Article
- Monitoring and evaluation strategies for surgical task-shifting and task-sharing interventions: a scoping review.Human resources for health · 2026Article
- Assessment of maternal and perinatal death surveillance and response (MPDSR) implementation in health facilities in Kigoma, Tanzania: a descriptive cross-sectional study.BMC pregnancy and childbirth · 2026Article
- Article
- Strategies to improve outcomes of obstetric emergencies in sub-Saharan Africa: A scoping review.PloS one · 2026Article
- Optimizing people's movement across the health system: a scoping review of referral systems within a primary health care approach.Primary health care research & development · 2025Article
- The paradox of enhancing male involvement in family planning uptake in rural Tanzania: insights from Bahi District, Dodoma Region.BMC health services research · 2025Article
- A Delphi process to build consensus on revised Emergency Obstetric and Newborn Care (EmONC) signal functions and levels of care.PloS one · 2025Article
- The impact of direct health facility financing on MNCH service provision: results from a comparative, before-after study in Pwani Region, Tanzania.BMC health services research · 2024Article
- Evaluation of the implementation fidelity of comprehensive emergency obstetric and newborn care at University of Gondar comprehensive specialized hospital, Northwest Ethiopia: a mixed-method evaluation.BMC pregnancy and childbirth · 2024Article
- Readiness to provide comprehensive emergency obstetric and neonatal care: a cross-sectional study in 30 health facilities in Tanzania.BMC health services research · 2024Article
- Evaluation of an obstetric and neonatal care upskilling program for community health workers in Papua New Guinea.BMC pregnancy and childbirth · 2024Article
- Service delivery redesign is a process, not a model of care.BMJ (Clinical research ed.) · 2023Article
- Context Matters: Strategies to Improve Maternal and Newborn Health Services in Sub-Saharan Africa.Global health, science and practice · 2022Article
- Improving Maternal and Reproductive Health in Kigoma, Tanzania: A 13-Year Initiative.Global health, science and practice · 2022Article
Corrections and comments
- Commented on by
Authors and funding
12 authors.
Funding
No grant is acknowledged in the PubMed record.
Abstract
introductionTo address high levels of maternal mortality in Kigoma, Tanzania, stakeholders increased women's access to high-quality comprehensive emergency obstetric and newborn care (EmONC) by decentralizing services from hospitals to health centers where EmONC was delivered mostly by associate clinicians and nurses. To ensure that women used services, implementers worked to continuously improve and sustain quality of care while creating demand.
methodsProgram evaluation included periodic health facility assessments, pregnancy outcome monitoring, and enhanced maternal mortality detection region-wide in program- and nonprogram-supported health facilities.
resultsBetween 2013 and 2018, the average number of lifesaving interventions performed per facility increased from 2.8 to 4.7. The increase was higher in program-supported than nonprogram-supported health centers and dispensaries. The institutional delivery rate increased from 49% to 85%; the greatest increase occurred through using health centers (15% to 25%) and dispensaries (21% to 46%). The number of cesarean deliveries almost doubled, and the population cesarean delivery rate increased from 2.6% to 4.5%. Met need for emergency obstetric care increased from 44% to 61% while the direct obstetric case fatality rate declined from 1.8% to 1.4%. The institutional maternal mortality ratio across all health facilities declined from 303 to 174 deaths per 100,000 live births. The total stillbirth rate declined from 26.7 to 12.8 per 1,000 births. The predischarge neonatal mortality rate declined from 10.7 to 7.6 per 1,000 live births. Changes in case fatality rate and maternal mortality were driven by project-supported facilities. Changes in neonatal mortality varied depending on facility type and program support status.
conclusionDecentralizing high-quality comprehensive EmONC delivered mostly by associate clinicians and nurses led to significant improvements in the availability and utilization of lifesaving care at birth in Kigoma. Dedicated efforts to sustain high-quality EmONC along with supplemental programmatic components contributed to the reduction of maternal and perinatal mortality.
Indexed as
Identifiers
What Socratic holds
Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the Socratic graph.