645 - Maternal Child Health Emergencies in Tanzania: A Mixed-Methods Analysis of System Readiness and Provider Experience

Publication Number: 3625.645

Sharla Rent, Duke University School of Medicine, Chapel Hill, NC, United States; Lexi Nussbaum, Duke University School of Medicine, Durham, NC, United States; Elizabeth M. Keating, University of Utah, Salt Lake City, UT, United States; Getrude M. Nkini, KCMC-Duke Collaboration, Moshi mjini, Kilimanjaro, Tanzania; Kimran Sidhu, Duke University School of Medicine, Durham, NC, United States; Irene R. Mushi, KCMC DUKE COLLABORATION, MOSHI, Kilimanjaro, Tanzania; James Segars, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, United States; Julius Raymond. Kingazi, KCMC-Duke Collaboration, Moshi, Kilimanjaro, Tanzania; Rosalia E. Njau, Kilimanjaro Christian Medical Centre, Kilimanjaro, Kilimanjaro, Tanzania; Lauren M. Rosenberg, Duke University Global Health Institute, Durham, NC, United States; Catherine Staton, Duke University School of Medicine, Durham, NC, United States; Raziya Gaffur, Kilimanjaro Christian Medical Centre, Moshi, Kilimanjaro, Tanzania; Frida Shayo, KCMC University, Moshi, Kilimanjaro, Tanzania; Aisa M. Shayo, KCMC University, Moshi, Kilimanjaro, Kilimanjaro, Tanzania

Background: Maternal, neonatal, and pediatric deaths remain key global health challenges, especially in Low and Middle-Income Countries (LMICs) like Tanzania. Many of these deaths occur in emergency settings and are related to lack of quality care. The World Health Organization's Hospital Emergency Unit Assessment Tool (HEAT) has been used in Tanzania to assess the capacity of regional health centers to respond to emergencies. However, this tool was insufficient to assess capacity to respond to Maternal-Child Health (MCH) emergencies. Our in 2024, our team created an MCH-adapted HEAT.

Objective: This study assesses the capacity of the Kilimanjaro region of Tanzania to provide timely and appropriate emergency care to pregnant women, newborns, and children by 1) using the MCH HEAT to assess MCH emergency capacity, 2) qualitatively describing the provider-experience surrounding MCH emergency care including debriefing and the provision of psychosocial support to families and healthcare workers.

Design/Methods: The MCH HEAT was administered at 7 health facilities, with data input directly into a REDCap database. At each site, 3-4 healthcare leaders completed the survey with responses averaged across users at the facility level. Results were summarized with descriptive statistics. In parallel, two focus groups were held at each site - one focused on obstetric and one on pediatric emergencies. Focus group data were thematically coded using a directed content analysis combining a priori codes derived from relevant literature and inductive coding.

Results: 26 providers completed the MCH HEAT and 88 participated across 16 qualitative focus groups. Participant demographics are shown in Table 1. The MCH HEAT revealed near full system coverage of functions such as electricity, running water, ambulance access, and supplemental oxygen.(Table 2) Key gaps were the availability of crash carts in the emergency department and labor ward with appropriate adult and pediatric sized equipment, as well as frequent shortages of essential medications. Focus groups highlighted gaps in resources, training, debriefing support, and communication skills when relaying bad news to families.(Figure 1) Obstetric and pediatric emergency providers also expressed a desire for mental health and coping support for the medical team following traumatic clinical scenarios such as patient deaths.

Conclusion(s): Health system investment across the Kilimanjaro region can focus on improvements in infrastructure and training alongside efforts to advance the quality of skills such as debriefing, provider-family communication, and trauma-informed peer support.

Table 1: Participant Demographics and Site Characteristics


Table 2: Service Availability at MCH HEAT Sites


Figure 1: Healthcare Provider Reported Barriers in Maternal and Child Emergency Care.
Focus group discussions identified domains affecting emergency care quality, management, and post-emergency support. Themes included: 1) insufficient resources, equipment, and training, 2) delays in referral systems, 3) treatment barriers, 4) dealing with death and end-of-life communication, 5) psychological toll and support for healthcare workers, and 6) support systems for families. Representative quotes from obstetric, pediatric, and neonatal emergency providers illustrate first-hand accounts of these themes.