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Mfinanga GS, Kimaro GD, Ngadaya E, et al. Health facility-based Active Management of the Third Stage of Labor: findings from a national survey in Tanzania. Health Res Policy Syst. 2009;7:6doi: 10.1186/1478-4505-7-6.
Mfinanga, G. S., Kimaro, G. D., Ngadaya, E., Massawe, S., Mtandu, R., Shayo, E. H., Kahwa, A., Achola, O., Mutungi, A., Knight, R., Armbruster, D., Sintasath, D., Kitua, A., & Stanton, C. (2009). Health facility-based Active Management of the Third Stage of Labor: findings from a national survey in Tanzania. Health research policy and systems, 76. https://doi.org/10.1186/1478-4505-7-6
Mfinanga, Godfrey S, et al. "Health facility-based Active Management of the Third Stage of Labor: findings from a national survey in Tanzania." Health research policy and systems vol. 7 (2009): 6. doi: https://doi.org/10.1186/1478-4505-7-6
Mfinanga GS, Kimaro GD, Ngadaya E, Massawe S, Mtandu R, Shayo EH, Kahwa A, Achola O, Mutungi A, Knight R, Armbruster D, Sintasath D, Kitua A, Stanton C. Health facility-based Active Management of the Third Stage of Labor: findings from a national survey in Tanzania. Health Res Policy Syst. 2009 Apr 16;7:6. doi: 10.1186/1478-4505-7-6. PMID: 19371418; PMCID: PMC2676279.
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Health Res Policy Syst. 2009 Apr 16;7:6. doi: 10.1186/1478-4505-7-6.

Health facility-based Active Management of the Third Stage of Labor: findings from a national survey in Tanzania.

Health research policy and systems

Godfrey S Mfinanga, Godfather D Kimaro, Esther Ngadaya, Sirili Massawe, Rugola Mtandu, Elizabeth H Shayo, Amos Kahwa, Ominde Achola, Alice Mutungi, Rod Knight, Deborah Armbruster, David Sintasath, Andrew Kitua, Cynthia Stanton

Affiliations

  1. NIMR Muhimbili Medical Research Centre (MMRC), Dar es Salaam, Tanzania. [email protected]

PMID: 19371418 PMCID: PMC2676279 DOI: 10.1186/1478-4505-7-6

Abstract

BACKGROUND: Hemorrhage is the leading cause of obstetric mortality. Studies show that Active Management of Third Stage of Labor (AMTSL) reduces Post Partum Hemorrhage (PPH). This study describes the practice of AMTSL and barriers to its effective use in Tanzania.

METHODS: A nationally-representative sample of 251 facility-based vaginal deliveries was observed for the AMTSL practice. Standard Treatment Guidelines (STG), the Essential Drug List and medical and midwifery school curricula were reviewed. Drug availability and storage conditions were reviewed at the central pharmaceutical storage site and pharmacies in the selected facilities. Interviews were conducted with hospital directors, pharmacists and 106 health care providers in 29 hospitals visited. Data were collected between November 10 and December 15, 2005.

RESULTS: Correct practice of AMTSL according to the ICM/FIGO definition was observed in 7% of 251 deliveries. When the definition of AMTSL was relaxed to allow administration of the uterotonic drug within three minutes of fetus delivery, the proportion of AMTSL use increased to 17%. The most significant factor contributing to the low rate of AMTSL use was provision of the uterotonic drug after delivery of the placenta. The study also observed potentially-harmful practices in approximately 1/3 of deliveries. Only 9% out of 106 health care providers made correct statements regarding the all three components of AMTSL. The national formulary recommends ergometrine (0.5 mg/IM) or oxytocin (5 IU/IM) on delivery of the anterior shoulder or immediately after the baby is delivered. Most of facilities had satisfactory stores of drugs and supplies. Uterotonic drugs were stored at room temperature in 28% of the facilities.

CONCLUSION: The knowledge and practice of AMTSL is very low and STGs are not updated on correct AMTSL practice. The drugs for AMTSL are available and stored at the right conditions in nearly all facilities. All providers used ergometrine for AMTSL instead of oxytocin as recommended by ICM/FIGO. The study also observed harmful practices during delivery. These findings indicate that there is a need for updating the STGs, curricula and training of health providers on AMTSL and monitoring its practice.

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