Delivery of integrated infectious disease control services under the new antenatal care guidelines: a service availability and readiness assessment of health facilities in Tanzania.

Publisher: BioMed Central Country of Publication: England NLM ID: 101088677 Publication Model: Electronic Cited Medium: Internet ISSN: 1472-6963 (Electronic) Linking ISSN: 14726963 NLM ISO Abbreviation: BMC Health Serv Res Subsets: MEDLINE

Original Publication: London : BioMed Central, [2001-

Delivery of Health Care, Integrated* ; Health Facilities*/standards ; Health Facilities*/supply & distribution ; Prenatal Care*; Communicable Disease Control/*organization & administration; Adult ; Cross-Sectional Studies ; Databases, Factual ; Female ; Guidelines as Topic ; Health Personnel ; Humans ; Logistic Models ; Malaria ; Mass Screening ; Pregnancy ; Tanzania

Background: Tanzania remains among the countries with the highest burden of infectious diseases (notably HIV, Malaria and Tuberculosis) during pregnancy. In response, the country adopted World Health Organization's (WHO) latest antenatal care (ANC) guidelines which recommend comprehensive services including diagnostic screening and treatment for pregnant women during antenatal. However, as Tanzania makes efforts to scale up these services under the existing health system resources, it is crucial to understand its capacity to deliver these services in an integrated fashion. Using the WHO's service availability and readiness assessment(SARA) framework, this study assesses the capacity of the Tanzanian Health System to provide integrated Malaria, Tuberculosis and HIV services.
Methods: Composite indicators of the five components of integration were constructed from primary datasets of the Tanzanian Service Provision Assessments (SPA) under the Demographic and Health Survey (DHS) programs. Chi-squared analysis, T test and ANOVA were conducted to determine the associations of each of the defined components and background characteristics of facilities/health workers. A logistic regression model was further used to explore strength of relationships between availability of service readiness components and a pregnant women's receipt of HIV, Malaria and TB services by reporting adjusted odds ratios.
Results: Generally, capacity to integrate malaria services was significantly higher (72.3 95% CI 70.3-74.4 p = 0.02) compared to Tuberculosis (48.9 95% CI 48.4-50.7) and HIV (54.8 95% CI 53.1-56.9) services. Diagnostic capacity was generally higher than treatment commodities. Regarding the components of SARA integration, logistic regression found that the adjusted odds ratio of having all five components of integration and receiving integrated care was 1.9 (95% CI 0.8-2.7). Among these components, the strongest determinant (predictor) to pregnant women's receipt of integrated care was having trained staff on site (AOR 2.6 95% CI 0.6-4.5).
Conclusion: Toward a successful integration of these services under the new WHO guidelines in Tanzania, efforts should be channelled into strengthening infectious disease care especially HIV and TB. Channelling investments into training of health workers (the strongest determinant to integrated care) is likely to result in positive outcomes for the pregnant woman and unborn child.

Erratum in: BMC Health Serv Res. 2021 Jul 9;21(1):676. (PMID: 34243761)

Unicef 2012. "Statistics" [online]. [viewed 12 may 2017]. Available from: https://www.unicef.org/infobycountry/tanzania_statistics.html.
Afnan-Holmes H, Magoma M, John T, Levira F, Msemo G, Armstrong CE, Martínez-Álvarez M, Kerber K, Kihinga C, Makuwani A, Rusibamayila N. Tanzania's countdown to 2015: an analysis of two decades of progress and gaps for reproductive, maternal, newborn, and child health, to inform priorities for post-2015. Lancet Glob Health. 2015;3(7):e396–409. (PMID: 10.1016/S2214-109X(15)00059-5)
UNDP 2015. Tanzania human development indices and indicators: 2018 statistical update [viewed September 24]. Available from: http://hdr.undp.org/sites/all/themes/hdr_theme/country-notes/TZA.pdf .
Mahande AM, Mahande MJ. Prevalence of parasitic infections and associations with pregnancy complications and outcomes in northern Tanzania: a registry-based cross-sectional study. BMC Infect Dis. 2016;16(1):78. (PMID: 10.1186/s12879-016-1413-6)
Antelman G, Msamanga GI, Spiegelman D, Urassa EJ, Narh R, Hunter DJ, Fawzi WW. Nutritional factors and infectious disease contribute to anemia among pregnant women with human immunodeficiency virus in Tanzania. J Nutr. 2000;130(8):1950–7. (PMID: 10.1093/jn/130.8.1950)
Dreyfuss ML, Msamanga GI, Spiegelman D, Hunter DJ, Urassa EJ, Hertzmark E, Fawzi WW. Determinants of low birth weight among HIV-infected pregnant women in Tanzania. Am J Clin Nutr. 2001;74(6):814–26. (PMID: 10.1093/ajcn/74.6.814)
Mullick S, Watson-Jones D, Beksinska M, Mabey D. Sexually transmitted infections in pregnancy: prevalence, impact on pregnancy outcomes, and approach to treatment in developing countries. Sex Transm Infect. 2005;81(4):294–302. (PMID: 10.1136/sti.2002.004077)
Mtei L, Matee M, Herfort O, Bakari M, Horsburgh CR, Waddell R, Cole BF, Vuola JM, Tvaroha S, Kreiswirth B, Pallangyo K. High rates of clinical and subclinical tuberculosis among HIV-infected ambulatory subjects in Tanzania. Clin Infect Dis. 2005;40(10):1500–7. (PMID: 10.1086/429825)
Kearns, a., Hurst, T., Caglia, J. and Langer, A., 2014. Focused antenatal Care in Tanzania. New York: Global Maternal Taskforce.
Tanzania Commission for AIDS (TACAIDS), Zanzibar AIDS Commission (ZAC), National Bureau of Statistics (NBS), Office of the Chief Government Statistician (OCGS), and ICF International. Tanzania HIV/AIDS and Malaria Indicator Survey 2011–12. Dar es Salaam, Tanzania: TACAIDS, ZAC, NBS, OCGS, and ICF International; 2013.
Gupta S, Yamada G, Mpembeni R, Frumence G, Callaghan-Koru J, Stevenson R, Brandes N, Baqui A. Factors associated with four or more antenatal care visits and its decline among pregnant women in Tanzania between 1999 and 2010. PLoS One. 2014;9(7):e101893. (PMID: 10.1371/journal.pone.0101893)
World Health Organisation (2017). New guidelines on antenatal care for a positive pregnancy experience. [online] World Health Organization. Available at: http://www.who.int/reproductivehealth/news/antenatal-care/en/ [Accessed 21 Sep. 2018].
Mallick L, Winter R, Wang W, and Yourkavitch J. Integration of Infectious Disease Services with Antenatal Care Services at Health Facilities in Kenya, Malawi, and Tanzania. DHS Analytical Studies No. 62. Rockville: ICF International; 2016.
World Health Organisation. Service availability and readiness assessment framework. Geneva: World Health Organisation and USAID; 2015.
Ministry of Health and Social Welfare. The National Road Map Strategic Plan to Accelerate Reduction of Maternal, Newborn and Child Deaths in Tanzania. Dar es Salaam: Ministry of Health and Social Welfare; 2008.
Ministry of Health and Social Welfare (MoHSW) [Tanzania Mainland], Ministry of Health (MoH) [Zanzibar], National Bureau of Statistics (NBS), Office of the Chief Government Statistician (OCGS), and ICF International 2015. Tanzania Service Provision Assessment Survey (TSPA) 2014–15. Dar es Salaam, Tanzania, and Rockville, Maryland, USA: MoHSW, MoH, NBS, OCGS, and ICF International.
Foreit KGF, Hardee K, Agarwal K. When does it make sense to consider integrating STI and HIV services with family planning services? Int Fam Plan Perspect. 2002:105–7.
Ouma PO, van Eijk AM, Hamel MJ, Sikuku ES, Odhiambo FO, Munguti KM, Ayisi JG, Crawford SB, Kager PA, Slutsker L. Antenatal and delivery care in rural western Kenya: the effect of training health care workers to provide" focused antenatal care". Reprod Health. 2010;7(1):1. (PMID: 10.1186/1742-4755-7-1)
Welty TK, Bulterys M, Welty ER, Tih PM, Ndikintum G, Nkuoh G, Nkfusai J, Kayita J, Nkengasong JN, Wilfert CM. Integrating prevention of mother-to-child HIV transmission into routine antenatal care: the key to program expansion in Cameroon. J Acquir Immune Defic Syndr. 2005;40(4):486–93. (PMID: 10.1097/01.qai.0000163196.36199.89)
Batalden PB, Davidoff F. What is “quality improvement” and how can it transform healthcare? Qual Saf Health Care. 2007;16(1):2. (PMID: 10.1136/qshc.2006.022046)
White J, O'Hanlon B, Chee G, Malangalila E, Kimambo A, Coarasa J, Callahan S, Ron Levey I, McKeon K. Private health sector assessment in Tanzania: The World Bank; 2013.

Keywords: Antenatal care; Infectious diseases; Readiness assessment; Service integration; Tanzania

Date Created: 20190315 Date Completed: 20190510 Latest Revision: 20210710

20221213

PMC6417178

10.1186/s12913-019-3990-8

30866924