Shija Angela E, Msovela Judith, Mboera Leonard E G
National Institute Medical Research, PO Box 9653, Dar es Salaam, Tanzania.
Tanzan J Health Res. 2011 Dec;13(5 Suppl 1):352-64. doi: 10.4314/thrb.v13i5.5.
High rate of maternal death is one of the major public health concerns in Tanzania. Most of maternal deaths are caused by factors attributed to pregnancy, childbirth and poor quality of health services. More than 80% of maternal deaths can be prevented if pregnant women access essential maternity care and assured of skilled attendance at childbirth as well as emergency obstetric care. The objective of this review was to analyse maternal mortality situation in Tanzania during the past 50 years and to identify efforts, challenges and opportunities of reducing it. This paper was written through desk review of key policy documents, technical reports, publications and available internet-based literature. From 1961 to 1990 maternal mortality ratio in Tanzania had been on a downward trend from 453 to 200 per 100,000 live births. However, from 1990's there been an increasing trend to 578 per 100,000 live births. Current statistics indicate that maternal mortality ratio has dropped slightly in 2010 to 454 per 100,000 live births. Despite a high coverage (96%) in pregnant women who attend at least one antenatal clinic, only half of the women (51%) have access to skilled delivery. Coverage of emergence obstetric services is 64.5% and utilization of modern family planning method is 27%. Only about 13% of home deliveries access post natal check-up. Despite a number of efforts maternal mortality is still unacceptably high. Some of the efforts done to reduce maternal mortality in Tanzania included the following initiatives: reproductive and child survival; increased skilled delivery; maternal death audit; coordination and integration of different programs including maternal and child health services, family planning, malaria interventions, expanded program on immunization and adolescent health and nutrition programmes. These initiatives are however challenged by inadequate access to maternal health care services. In order to considerably reduce maternal deaths some of recommended strategies include: (i) strengthening the health system to provide skilled attendance during child birth; (ii) upgrading rural health centres to provide emergency obstetric services; (iii) providing adolescent and male friendly family planning services; (iv) strengthening public-private partnership to ensure continuum of care; (v) supporting operational research to answer the immediate concerns of the health system; and (vi) strengthening community participation and women empowerment to take role of their own health and the family at large. In conclusion, maternal mortality ratio in Tanzania is unacceptably high and still very far from reaching the millennium development goals. Maternal health care services should focus on ensuring there is continuum of care through strengthening the health system; provision of good quality of health care in a well organized referral health system and operation research to support programme implementation.
孕产妇死亡率居高不下是坦桑尼亚主要的公共卫生问题之一。大多数孕产妇死亡是由与怀孕、分娩及医疗服务质量差相关的因素导致的。如果孕妇能够获得基本的孕产妇保健服务，并确保在分娩时有专业人员在场以及能得到产科急诊护理，那么80%以上的孕产妇死亡是可以预防的。本综述的目的是分析坦桑尼亚过去50年的孕产妇死亡情况，并确定降低孕产妇死亡率的努力、挑战和机遇。本文通过对关键政策文件、技术报告、出版物及现有的网络文献进行案头审查撰写而成。1961年至1990年期间，坦桑尼亚的孕产妇死亡率呈下降趋势，从每10万例活产453例降至200例。然而，从20世纪90年代起，这一比率呈上升趋势，达到每10万例活产578例。当前统计数据表明，2010年孕产妇死亡率略有下降，降至每10万例活产454例。尽管至少去过一次产前诊所的孕妇覆盖率很高（96%），但只有一半的妇女（51%）能够获得专业接生服务。产科急诊服务的覆盖率为64.5%，现代计划生育方法的使用率为27%。只有约13%的在家分娩妇女能够接受产后检查。尽管做出了诸多努力，但孕产妇死亡率仍然高得令人无法接受。坦桑尼亚为降低孕产妇死亡率所做的一些努力包括以下举措：生殖与儿童生存；增加专业接生服务；孕产妇死亡审计；协调和整合包括孕产妇和儿童保健服务、计划生育、疟疾防治、扩大免疫规划以及青少年健康与营养项目在内的不同项目。然而，这些举措面临着孕产妇保健服务获取不足的挑战。为大幅降低孕产妇死亡，一些推荐策略包括：（i）加强卫生系统，以便在分娩时提供专业人员在场服务；（ii）升级农村保健中心，以提供产科急诊服务；（iii）提供对青少年和男性友好的计划生育服务；（iv）加强公私伙伴关系，以确保连续护理；（v）支持开展行动研究，以解决卫生系统的紧迫问题；（vi）加强社区参与和妇女赋权，使她们能够在自身及整个家庭的健康方面发挥作用。总之，坦桑尼亚的孕产妇死亡率高得令人无法接受，距离实现千年发展目标仍相差甚远。孕产妇保健服务应注重通过加强卫生系统来确保连续护理；在组织完善的转诊卫生系统中提供高质量的医疗保健服务，并开展行动研究以支持项目实施。
