Improvements in Obstetric and Newborn Health Information Documentation following the Implementation of the Safer Births Bundle of Care at 30 Facilities in Tanzania
Abstract
:1. Introduction
2. Materials and Methods
2.1. Design, Management, Sites, and Population
2.2. The SBBC Project and Implementation Strategy
2.3. Data Collection and Management
2.4. Variables Included in This Analysis
2.5. Statistical Methods
2.6. Ethical Considerations
3. Results
3.1. Overall Findings
3.2. Comparison of Non-Documentation across Health Facility Levels
3.3. Comparison of Non-Documentation across Regions
3.4. The Relative Number of HCWs and Case Note Documentation
4. Discussion
5. Conclusions
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Acknowledgments
Conflicts of Interest
References
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All | All Sites | Regional Referral Hospital | District Hospital Level | Health Centre Level | ||||
---|---|---|---|---|---|---|---|---|
Baseline (N = 67,775) | Implementation (N = 70,667) | Baseline (N = 12,059) | Implementation (N = 10,151) | Baseline (N = 34,699) | Implementation (N = 39,699) | Baseline (N = 21,017) | Implementation (N = 20,817) | |
Any missing p < 0.0001 | ||||||||
Missing | 53,706 (79.2) | 49,463 (70.0) | 7278 (60.4) | 4857 (47.8) | 30,041 (86.6) | 30,024 (75.6) | 16,387 (78.0) | 14,582 (70.0) |
Not missing | 14,069 (20.8) | 21,204 (30.0) | 4781 (39.6) | 5294 (52.2) | 4658 (13.4) | 9675 (24.4) | 4630 (22.0) | 6235 (30.0) |
Gestational age p < 0.0001 | ||||||||
Missing | 28,622 (42.2) | 24,168 (34.2) | 2419 (20.1) | 1935 (19.1) | 19,182 (55.3) | 15,533 (39.1) | 7021 (33.4) | 6700 (32.2) |
Not missing | 39,153 (57.8) | 46,499 (65.8) | 9640 (79.9) | 8216 (80.9) | 15,517 (44.7) | 24,166 (60.9) | 13,996 (66.6) | 14,117 (67.8) |
Amniotic fluid colour p < 0.0001 | ||||||||
Missing | 27,517 (40.6) | 21,067 (29.8) | 3484 (28.9) | 1683 (16.6) | 13,558 (39.1) | 12,947 (32.6) | 10,475 (49.8) | 6437 (30.9) |
Not missing | 40,258 (59.4) | 49,600 (70.2) | 8575 (71.1) | 8468 (83.4) | 21,141 (60.9) | 26,752 (67.4) | 10,542 (50.2) | 14,380 (69.1) |
Duration of 2nd stage of labour p < 0.0001 | ||||||||
Missing | 18,599 (27.4) | 12,160 (17.2) | 2353 (19.5) | 537 (5.3) | 11,770 (33.9) | 6520 (16.4) | 4476 (21.3) | 5103 (24.5) |
Not missing | 49,176 (72.6) | 58,507 (82.8) | 9706 (80.5) | 9614 (94.7) | 22,929 (66.1) | 33,179 (83.6) | 16,541 (78.7) | 15,714 (75.5) |
FHR monitoring during labour p < 0.0001 | ||||||||
Missing | 16,403 (24.2) | 13,753 (19.5) | 2495 (20.7) | 1376 (13.6) | 9487 (27.3) | 7623 (19.2) | 4421 (21.0) | 4754 (22.8) |
Not missing | 51,372 (75.8) | 56,914 (80.5) | 9564 (79.3) | 8775 (86.4) | 25,212 (72.7) | 32,076 (80.8) | 16,596 (79.0) | 16,063 (77.2) |
ANC attendance p < 0.0001 | ||||||||
Missing | 6323 (9.3) | 4707 (6.7) | 726 (6.0) | 300 (3.0) | 4517 (13.0) | 3084 (7.8) | 1080 (5.1) | 1323 (6.4) |
Not missing | 61,452 (90.7) | 65,960 (93.3) | 11,333 (94.0) | 9851 (97.0) | 30,182 (87.0) | 36,615 (92.2) | 19,937 (94.9) | 19,494 (93.6) |
ANC problem p = 0.4185 | ||||||||
Missing | 6640 (9.8) | 7016 (9.9) | 1316 (10.9) | 1086 (10.7) | 3636 (10.5) | 3351 (8.4) | 1688 (8.0) | 2579 (12.4) |
Not missing | 61,135 (90.2) | 63,651 (90.1) | 10,743 (89.1) | 9065 (89.3) | 31,063 (89.5) | 36,348 (91.6) | 19,329 (92.0) | 18,238 (87.6) |
Presentation p = 0.0183 | ||||||||
Missing | 7255 (10.7) | 7845 (11.1) | 495 (4.1) | 243 (2.4) | 4823 (13.9) | 4828 (12.2) | 1937 (9.2) | 2774 (13.3) |
Not missing | 60,520 (89.3) | 62,822 (88.9) | 11,564 (95.9) | 9908 (97.6) | 29,876 (86.1) | 34,871 (87.8) | 19,080 (90.8) | 18,043 (86.7) |
Birth outcome (at 30 min p < 0.0001) | ||||||||
Missing | 281 (0.4) | 0 (0.0) | 229 (1.9) | 0 (0.0) | 31 (0.1) | 0 (0.0) | 21 (0.1) | 0 (0.0) |
Not missing | 67,494 (99.6) | 70,667 (100.0) | 11,830 (98.1) | 10,151 (100.0) | 34,668 (99.9) | 39,699 (100.0) | 20,996 (99.9) | 20,817 (100.0) |
24 h outcomes p < 0.0001 | ||||||||
Missing | 1452 (2.1) | 193 (0.3) | 544 (4.5) | 72 (0.7) | 876 (2.5) | 113 (0.3) | 32 (0.2) | 8 (0.0) |
Not missing | 66,323 (97.9) | 70,474 (99.7) | 11,515 (95.5) | 10,079 (99.3) | 33,823 (97.5) | 39,586 (99.7) | 20,985 (99.8) | 20,809 (100.0) |
Maternal outcome at discharge p < 0.0001 | ||||||||
Missing | 1653 (2.4) | 141 (0.2) | 160 (1.3) | 16 (0.2) | 1450 (4.2) | 116 (0.3) | 43 (0.2) | 9 (0.0) |
Not missing | 66,122 (97.6) | 70,526 (99.8) | 11,899 (98.7) | 10,135 (99.8) | 33,249 (95.8) | 39,583 (99.7) | 20,974 (99.8) | 20,808 (100.0) |
Duration of 1st stage of labour p < 0.0001 | ||||||||
Missing | 35,075 (51.8) | 32,435 (45.9) | 5093 (42.2) | 3020 (29.8) | 21,472 (61.9) | 20,145 (50.7) | 8510 (40.5) | 9270 (44.5) |
Not missing | 32,700 (48.2) | 38,232 (54.1) | 6966 (57.8) | 7131 (70.2) | 13,227 (38.1) | 19,554 (49.3) | 12,507 (59.5) | 11,547 (55.5) |
All | Manyara | Tabora | Geita | Shinyanga | Mwanza | |||||
---|---|---|---|---|---|---|---|---|---|---|
Baseline (N = 4943) | Implementation (N = 15,658) | Baseline (N = 7382) | Implementation (N = 14,365) | Baseline (N = 19,307) | Implementation (N = 19,073) | Baseline (N = 15,545) | Implementation (N = 8453) | Baseline (N = 20,598) | Implementation (N = 13,118) | |
Any missing p < 0.0001 | ||||||||||
Missing | 4312 (87.2) | 11,378 (72.7) | 6237 (84.5) | 10,334 (71.9) | 14,936 (77.4) | 13,206 (69.2) | 11,042 (71.0) | 5733 (67.8) | 17,179 (83.4) | 8812 (67.2) |
Not missing | 631 (12.8) | 4280 (27.3) | 1145 (15.5) | 4031 (28.1) | 4371 (22.6) | 5867 (30.8) | 4503 (29.0) | 2720 (32.2) | 3419 (16.6) | 4306 (32.8) |
Gestational age p < 0.0001 | ||||||||||
Missing | 3031 (61.3) | 5056 (32.3) | 4888 (66.2) | 7221 (50.3) | 7939 (41.1) | 6814 (35.7) | 3689 (23.7) | 1984 (23.5) | 9075 (44.1) | 3093 (23.6) |
Not missing | 1912 (38.7) | 10,602 (67.7) | 2494 (33.8) | 7144 (49.7) | 11,368 (58.9) | 12,259 (64.3) | 11,856 (76.3) | 6469 (76.5) | 11,523 (55.9) | 10,025 (76.4) |
Amniotic fluid colour p < 0.0001 | ||||||||||
Missing | 2529 (51.2) | 6661 (42.5) | 2413 (32.7) | 2448 (17.0) | 9114 (47.2) | 6668 (35.0) | 6789 (43.7) | 3520 (41.6) | 6672 (32.4) | 1770 (13.5) |
Not missing | 2414 (48.8) | 8997 (57.5) | 4969 (67.3) | 11,917 (83.0) | 10,193 (52.8) | 12,405 (65.0) | 8756 (56.3) | 4933 (58.4) | 13,926 (67.6) | 11,348 (86.5) |
Duration of 2nd stage of labour p < 0.0001 | ||||||||||
Missing | 1928 (39.0) | 1923 (12.3) | 1861 (25.2) | 836 (5.8) | 4317 (22.4) | 5009 (26.3) | 3849 (24.8) | 1832 (21.7) | 6644 (32.3) | 2560 (19.5) |
Not missing | 3015 (61.0) | 13,735 (87.7) | 5521 (74.8) | 13,529 (94.2) | 14,990 (77.6) | 14,064 (73.7) | 11,696 (75.2) | 6621 (78.3) | 13,954 (67.7) | 10,558 (80.5) |
FHR monitoring during labour p < 0.0001 | ||||||||||
Missing | 1733 (35.1) | 3615 (23.1) | 2012 (27.3) | 2283 (15.9) | 5019 (26.0) | 5275 (27.7) | 2155 (13.9) | 963 (11.4) | 5484 (26.6) | 1617 (12.3) |
Not missing | 3210 (64.9) | 12,043 (76.9) | 5370 (72.7) | 12,082 (84.1) | 14,288 (74.0) | 13,798 (72.3) | 13,390 (86.1) | 7490 (88.6) | 15,114 (73.4) | 11,501 (87.7) |
ANC attendance p < 0.0001 | ||||||||||
Missing | 708 (14.3) | 970 (6.2) | 1442 (19.5) | 579 (4.0) | 1256 (6.5) | 1529 (8.0) | 692 (4.5) | 893 (10.6) | 2225 (10.8) | 736 (5.6) |
Not missing | 4235 (85.7) | 14,688 (93.8) | 5940 (80.5) | 13,786 (96.0) | 18,051 (93.5) | 17,544 (92.0) | 14,853 (95.5) | 7560 (89.4) | 18,373 (89.2) | 12,382 (94.4) |
ANC problem p = 0.4185 | ||||||||||
Missing | 936 (18.9) | 1472 (9.4) | 1273 (17.2) | 1348 (9.4) | 1461 (7.6) | 2681 (14.1) | 533 (3.4) | 726 (8.6) | 2437 (11.8) | 789 (6.0) |
Not missing | 4007 (81.1) | 14,186 (90.6) | 6109 (82.8) | 13,017 (90.6) | 17,846 (92.4) | 16,392 (85.9) | 15,012 (96.6) | 7727 (91.4) | 18,161 (88.2) | 12,329 (94.0) |
Presentation p = 0.0183 | ||||||||||
Missing | 259 (5.2) | 1157 (7.4) | 424 (5.7) | 913 (6.4) | 2,59 (13.3) | 3333 (17.5) | 1271 (8.2) | 1487 (17.6) | 2742 (13.3) | 955 (7.3) |
Not missing | 4684 (94.8) | 14,501 (92.6) | 6958 (94.3) | 13,452 (93.6) | 16,748 (86.7) | 15,740 (82.5) | 14,274 (91.8) | 6966 (82.4) | 17,856 (86.7) | 12,163 (92.7) |
Birth outcomes (at 30 min p < 0.0001) | ||||||||||
Missing | 6 (0.1) | 0 (0.0) | 11 (0.1) | 0 (0.0) | 30 (0.2) | 0 (0.0) | 215 (1.4) | 0 (0.0) | 19 (0.1) | 0 (0.0) |
Not missing | 4937 (99.9) | 15,658 (100.0) | 7371 (99.9) | 14,365 (100.0) | 19,277 (99.8) | 19,073 (100.0) | 15,330 (98.6) | 8453 (100.0) | 20,579 (99.9) | 13,118 (100.0) |
24 h outcomes p < 0.0001 | ||||||||||
Missing | 630 (12.7) | 61 (0.4) | 212 (2.9) | 25 (0.2) | 48 (0.2) | 4 (0.0) | 253 (1.6) | 86 (1.0) | 309 (1.5) | 17 (0.1) |
Not missing | 4313 (87.3) | 15,597 (99.6) | 7170 (97.1) | 14,340 (99.8) | 19,259 (99.8) | 19,069 (100.0) | 15,292 (98.4) | 8367 (99.0) | 20,289 (98.5) | 13,101 (99.9) |
Maternal outcomes at discharge p < 0.0001 | ||||||||||
Missing | 457 (9.2) | 61 (0.4) | 57 (0.8) | 18 (0.1) | 53 (0.3) | 12 (0.1) | 998 (6.4) | 41 (0.5) | 88 (0.4) | 9 (0.1) |
Not missing | 4486 (90.8) | 15,597 (99.6) | 7325 (99.2) | 14,347 (99.9) | 19,254 (99.7) | 19,061 (99.9) | 14,547 (93.6) | 8412 (99.5) | 20,510 (99.6) | 13,109 (99.9) |
Duration of 1st stage of labour p < 0.0001 | ||||||||||
Missing | 3080 (62.3) | 7905 (50.5) | 3806 (51.6) | 5073 (35.3) | 7915 (41.0) | 8486 (44.5) | 7025 (45.2) | 4262 (50.4) | 13,249 (64.3) | 6709 (51.1) |
Not missing | 1863 (37.7) | 7753 (49.5) | 3576 (48.4) | 9292 (64.7) | 11,392 (59.0) | 10,587 (55.5) | 8520 (54.8) | 4191 (49.6) | 7349 (35.7) | 6409 (48.9) |
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Kamala, B.A.; Ersdal, H.; Moshiro, R.; Mduma, E.; Baker, U.; Guga, G.; Kvaløy, J.T.; Bishanga, D.R.; Bundala, F.; Marwa, B.; et al. Improvements in Obstetric and Newborn Health Information Documentation following the Implementation of the Safer Births Bundle of Care at 30 Facilities in Tanzania. Healthcare 2024, 12, 319. https://doi.org/10.3390/healthcare12030319
Kamala BA, Ersdal H, Moshiro R, Mduma E, Baker U, Guga G, Kvaløy JT, Bishanga DR, Bundala F, Marwa B, et al. Improvements in Obstetric and Newborn Health Information Documentation following the Implementation of the Safer Births Bundle of Care at 30 Facilities in Tanzania. Healthcare. 2024; 12(3):319. https://doi.org/10.3390/healthcare12030319
Chicago/Turabian StyleKamala, Benjamin Anathory, Hege Ersdal, Robert Moshiro, Estomih Mduma, Ulrika Baker, Godfrey Guga, Jan Terje Kvaløy, Dunstan R. Bishanga, Felix Bundala, Boniphace Marwa, and et al. 2024. "Improvements in Obstetric and Newborn Health Information Documentation following the Implementation of the Safer Births Bundle of Care at 30 Facilities in Tanzania" Healthcare 12, no. 3: 319. https://doi.org/10.3390/healthcare12030319