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Half a million women die from complications related to pregnancy and childbirth each year, with 99% of these deaths occurring in developing countries (Hill et al. 2007; WHO, 2008). The major direct obstetric causes of maternal death include hemorrhages (25%), pre-eclampsia/eclampsia (8%), sepsis (15%), prolonged/obstructed labor (12%), and complications of abortion (13%) (Khan et al 2006). Millennium Development Goal 5 (MDG5) aims to reduce maternal mortality by 75% worldwide by 2015. Unfortunately, maternal mortality has decreased by less than 1% per year from 1990 to 2005, lagging far behind the target (United Nations, 2007). In addition, each year, 15 million women suffer severe or long-lasting complications related to pregnancy including: (1) infertility, (2) depression, (3) debt resulting from medical fees, (4) increased violence related to marital disharmony, and (5) obstetric fistula (Hindin, 2007).

Neonatal mortality is also a global health problem with four million babies dying and another 3.3 million stillbirths each year. Neonatal mortality rates are highest in Africa and South Central Asia at 41 and 43 per 1000 live births, respectively. Causes of neonatal and perinatal deaths include: (1) poor maternal health, (2) inadequate care in pregnancy, (3) mismanagement of pregnancy and birth complications, (4) poor hygiene practices during childbirth and after, and (5) lack of newborn care. Neonatal mortality accounts for 40% of under-five mortality and is thus essential to address to achieve MDG4 of reducing child mortality by two-thirds by 2015 (WHO, 2006).

MATERNAL AND CHILD HEALTH INDICATORS IN TANZANIA & TANGA

Neonatal, Infant and Under Five Mortality Rate

Neonatal mortality measures the probability of dying in the first month of life, while Infant mortality is the probability of dying before the first birthday and Under-five mortality provide probability of dying before the fifth birthday. These indicators reflect a country’s level of socio-economic development and quality of life. Analyzing these three indicators it can potentially predict the overall performance of the health sector. The rise or decline of these indicators is attributed to various social economic factors. Preliminary results from TDHS 2009/10 shows significant decline of child mortality in Tanzania specifically infant (IMR= 51/10,000) and Under Five Mortality Rate (U5MR= 81/10,000). However, high neonatal deaths remain a significant challenge, accounting for 32% of all under five deaths in Tanzania. In Tanga Region, infant mortality reported to be 96/10,000 live births while under five mortality were 140/10,000 births.

Maternal Mortality Ratio

Maternal mortality ratio is measured periodically through Tanzania Demographic and Health Surveys (TDHS). The latest estimate from TDHS 2004/05, estimated Maternal Mortality Ratio (MMR) at 578 maternal deaths per 100,000 live births. Preliminary results from TDHS of 2009/10 shows MMR has declined to 454 deaths per 100,000 live births. This is a notable improvement but relatively the maternal deaths are still high requiring more effort to attain MDG goal which is 265 per 1000,000 live births. Also, the same goal is used for the MKUKUTA target. The new estimates concede with the general trend observed from facility data which provide proxy estimates. It is categorized as a proxy indicator because it is only portion of all deaths which occurs at health facilities. Hence, the value reported is understated compared with community based information. However, in Tanga Region; Maternal Mortality ratio measured was 286/100,000 as reported in the year 2005 at health facilities and Traditional Birth Attendants.

Proportion of births attended in health facility in Tanzania and Tanga Region

This indicator measures the number of deliveries conducted in health facilities as the percent of the projected number of births. Basing on the 2009 HMIS/ Reproductive and Child Health (RCH) data, on average, 54% of deliveries in Tanzania were attended in health facilities. The 2009 data implies that health facility deliveries increased from 51% and 52% in 2007 and 2008, respectively. The 2005 TDHS results revealed that 37.5% of expected births took place in government facilities; 3.1% in non-profit facilities and 6.4% in private-for-profit facilities (making 47% overall). Recent TDHS 2009/10 preliminary result shows the proportion of births attended by trained personnel in health facility is 50.6% and 50.2% delivered in a health facility. In Tanga Region particular, in the year 2009, there were 65,939 total live births; where those delivered at health facilities were 38,397 and therefore, the percentage of delivery in health facility was only 58.2 percent. The general conclusion is that Compared with the 2015 HSPSIII target of 80%, this entail more effort is required to achieve 2015 HSSP III target.

PAST EXPERIENCE IN REDUCING MATERNAL AND CHILD MORTALITY IN TANGA:

The Case of Traditional Birth Attendants (TBAs) Supported by JICA in Tanga Region.

Reports shown that, 54.3 percent of all registered births in Tanga Region happened either in the health facility or under administration of the Tradition Birth Attendants (TBA) during the year 2006. A total of 227 trained traditional birth attendants (TBAs) were trained by JICA in order to enable them provide safer delivery service using sterilized delivery kits. MCH in Tanga Region, cost recovery for delivery was introduced, and 85 percent of the community women desired assistance from TBAs who were trained by JICA. Thus, it was expected that the activities of TBAs could ensure safer delivery if the TBA kits (hygienic and safer delivery kits, among which the consumable items are paid for by the beneficiaries) in trial use were permanently established. However, the current Tanzania Health Policy requires all births to be done at dispensaries, health centers or hospitals. Home delivery by use of TBAs is not that much promoted. When emergency home delivery occurs, it is really an emergency and not planned action; such delivery will reflect the real concept and application of Home Based Life Saving Skills (HBLSS) as proposed in project. In another scenario, the Government of Tanzania through Ministry of Health and Social Welfare provide free delivery kit for every pregnant mother; meaning that; pregnant mothers have been restricted to bring delivery kit to health facilities, all delivery kit are supposed to be provided to the health facilities.

TAKE ACTION TO PREVENT MATERNAL AND CHILD MORTALITY IN TANGA REGION: LINKING HOME-COMMUNITY AND HEALTH FACILITY THROUGH HOME BASED LIFE SAVING SKILLS (HBLSS) TRAININGS.

TUJIKOMBOE GROUP is inviting partners and donors to work together in by conducting Home Based Life Saving Skills (HBLSS) trainings in Tanga Region; in order to build capacity of District Home Based Life Saving Skills Facilitators (D-HBLSS Facilitators-who shall be Medical Officers, Registered Nurses and Nurse Midwives from Bombo Regional Hospital, District Hospitals and Health Centers); so that after been trained, they will be able to conduct HBLSS trainings to Dispensary workers and community health workers to the extent that will enable localization of HBLSS training down to the family level with the aim of reducing maternal and child mortality in Tanga region.

It has been found that; both maternal and neonatal mortality can be improved with the use of skilled delivery care; utilization of a skilled birth attendant is therefore a critical intervention to achieve MDG4 and 5. However, in the least developed countries, only 35% of births were attended by trained providers (WHO, 2007), making it essential to develop and test programs that focus on evidence- based interventions including a continuum of care, skilled attendance at birth and access to emergency obstetric care (Maine and Rosenfield, 1999; Freedman et al., 2005; Rosenfield et al., 2006). The provision of successful emergency obstetric care is dependent on the reduction of five major delays including: (1) delay in recognizing the problem, (2) delay in receiving emergency first aid, (3) delay in deciding to seek care at the onset of the emergency, (4) delay in seeking timely care, and (5) delay in getting quality, appropriate and effective care (Thaddeus and Maine, 1994; Miller et al., 2006). The first four delays occur at the household or community level, highlighting the importance of home and community-based interventions.

Home-based life saving skills (HBLSS), has been developed by the American College of Nurse Midwives (ACNM) Department of Global Outreach (Buffington etal. 2004), is a community-based, family-centered program developed with the aim of reducing maternal and newborn deaths. Objectives of the HBLSS program include :( 1) decreasing delays in recognition and response to major complications,(2) increasing access to emergency maternal and neonatal care, and(3)encouraging timely, appropriate emergency referral where referral is possible. HBLSS tend to increases access to basic life-saving care with the home and community. Home-Based Life Saving Skills (HBLSS) represent a critical rethinking of conventional community-based approaches in several ways, such that: take into account the social context of childbirth, focusing on the pregnant women, her family caregivers and the home birth attendant as a team: addressing the challenges of responding to unpredictable life-threatening complications, this includes problems recognitions, first aid care, referral decision-making and knowing where to get help. HBLLS also enhanced family and community to negotiate safe, feasible, acceptable actions that will be take in the home setting when life-threatening complications occurs.

HBLSS is a skills-based program designed for low or non- literate participants. Knowledge is disseminated through a training cascade starting with HBLSS District Trainers, HBLSS guides/Dispensary workers and finally family and community members. Emphasis is placed on respectful consideration of local knowledge; a key component is negotiation to come to agreement on actions to take during an obstetric or neonatal emergency. A variety of teaching strategies are utilized to promote the transfer of knowledge including: (1) skills checklists, (2) story-telling, (3) role-playing, and (4) ‘Take Action Cards’ (TAC). TAC is pictorial representations of a particular problem on one side with six small pictures of actions to take in response to the problem on the other side. Family and community members receive TAC following the HBLSS meetings.

HBLSS TOPICS TO BE COVERED

There are five topics of Home Based Life Saving Skills

1. Introduction(History of HBLSS, Its training cascade, Situation analysis of maternal and neonatal mortality in Tanzania and in the project area)
2. Basics information on women and babies(problems)
3. Prevent women and babies problems
4. Referrals: Women referral and Baby referral
5. Strengthening HBLSS training to community and family level and follow up strategy

 Previous Experience of Tujikomboe Group on works related to reduction of maternal and neonatal deaths in Tanzania.

Tujikomboe Group represented by its Founder & Organization Advisor-Mr. Shamsi Mhina; has been contracted by Plan International to train Medical Officers, Midwives Nurses and Registered Nurses in Kisarawe District-Coast Region and Ilemela District-Mwanza Region. This was done by training District-TOTs on Home-Based Life Saving Skills (HBLSS), who then trained Dispensary workers and Community Health Workers (CHW) on skills necessary to reduce maternal and neonatal deaths. Objectives of the HBLSS program include :( 1) decreasing delays in recognition and response to major complications,(2) increasing access to emergency maternal and neonatal care, and(3)encouraging timely, appropriate emergency referral where referral is possible. HBLSS tend to increases access to basic life-saving care with the home and community. HBLLS also enhanced family and community to negotiate safe, feasible, acceptable actions that will be take in the home setting when life-threatening complications occurs.

NOTE: TUJIKOMBOE GROUP IS A MEMBER OF WHITE RIBBON ALLIENCE FOR SAFE MOTHERHOOD.

WELL COME; JOIN OUR EFFORTS AND CONTRIBUTE TO THE STRATEGIC PROGRAM OF HBLSS THAT WILL ENHANCE TANZANIA TO REDUCE MATERNAL AND CHILD MORTALITY. CALL US 0754-677893 & 0718-603705: E-mail: mfusi@yahoo.com