Abstract:
Background: In Tanzania, maternal mortality ratio remains unacceptably high at 578/100,000 live births. Despite a
high coverage of antenatal care (96%), only 44% of deliveries take place within the formal health services. Still,
“Ensure skilled attendant at birth“ is acknowledged as one of the most effective interventions to reduce maternal
deaths. Exploring the potential of community-based interventions in increasing the utilization of obstetric care, the
study aimed at developing, testing and assessing a community-based safe motherhood intervention in Mtwara
rural District of Tanzania.
Method: This community-based intervention was designed as a pre-post comparison study, covering 4 villages
with a total population of 8300. Intervention activities were implemented by 50 trained safe motherhood
promoters (SMPs). Their tasks focused on promoting early and complete antenatal care visits and delivery with a
skilled attendant. Data on all 512 deliveries taking place from October 2004 to November 2006 were collected by
the SMPs and cross-checked with health service records. In addition 242 respondents were interviewed with
respect to knowledge on safe motherhood issues and their perception of the SMP’s performance. Skilled delivery
attendance was our primary outcome; secondary outcomes included antenatal care attendance and knowledge on
Safe Motherhood issues.
Results: Deliveries with skilled attendant significantly increased from 34.1% to 51.4% (r < 0.05). Early ANC booking
(4 to 16 weeks) rose significantly from 18.7% at baseline to 37.7% in 2005 and 56.9% (r < 0.001) at final
assessment. After two years 44 (88%) of the SMPs were still active, 79% of pregnant women were visited. Further
benefits included the enhancement of male involvement in safe motherhood issues.
Conclusion: The study has demonstrated the effectiveness of community-based safe motherhood intervention in
promoting the utilization of obstetric care and a skilled attendant at delivery. This improvement is attributed to the
SMPs’ home visits and the close collaboration with existing community structures as well as health services.
