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《妇产科期刊（英文）》
>Impact of Facility Delivery Intensity on the Practice of Active Management of Third Stage of Labour and Other Labour and Delivery Interventions in Tanzania
Impact of Facility Delivery Intensity on the Practice of Active Management of Third Stage of Labour and Other Labour and Delivery Interventions in Tanzania
Background: Postpartum haemorrhage (PPH) is the leading cause of maternal mortality globally and Tanzania particularly. The World Health Organisation recommends Active Management of Third Stage of Labour (AMTSL) in preventing PPH, but its correct implementation has generally remained low. Many factors have been associated with the low practice of AMTSL, but the literature on the impact of delivery intensity is scanty. The aim was to determine the impact of facility delivery intensity on correct practice of AMTSL and provision of other labour and delivery interventions. Methods: In 2016, an analytical cross-section study was conducted in four public health facilities in Dar es Salaam. A priori criterion was set at 10 daily deliveries or more for High Delivery Intensity Facilities (HDIFs) in contrast to Low Delivery Intensity Facilities (LDIFs). All public obstetric care hospitals and health centres were ranked such that one facility with the highest deliveries and one with the lowest deliveries per category were selected. All eligible deliveries between 8.00 am and 2.00 pm were studied. An observer was assigned to each facility to time and document delivery and third stage events. Data were entered and analysed using SPSS program version 20. Pearson Chi square test was used for categorical data and Student’s t-test for comparing continuous data. Clinical relevance of the differences was evaluated by using 95% confidence intervals. Statistics with p-value The study was ethically approved by MUHAS Senate Research and Publication Committee. Results: In total, 752 normal deliveries were observed including 376 in LDIFs and 376 in HDIFs. Socio-demographic characteristics of women were comparable in both, except that women with secondary or higher education were more delivered in LDIFs (60.4%) than in HDIFs (35.1%), p < 0.001. LDIFs were more likely to provide Oxytocin as recommended (OR = 4.0, 95% CI: 3.01 - 5.25) and to perform other life saving interventions than the HDIFs. Conclusions: Facility delivery intensity has remarkable impact on correct practice of AMTSL, labor and intra-partum care. Efforts to reduce maternal deaths should minimize facility delivery intensity.
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