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Original research
Impact evaluation of the TAMANI project to improve maternal and child health in Tanzania
  1. Erin Hetherington1,
  2. Sam Harper1,
  3. Rebecca Davidson2,
  4. Charles Festo3,
  5. Nadia Lampkin2,
  6. Sally Mtenga4,
  7. Clarissa Teixeira2,
  8. Ilona Vincent5,
  9. Arijit Nandi6
  1. 1 Department of Epidemiology, Biostatistics and Occupational Health, McGill University Faculty of Medicine and Health Sciences, Montreal, Quebec, Canada
  2. 2 CARE, Canada, Ottawa, Ontario, Canada
  3. 3 Ifakara Health Institute, Ifakara, Morogoro, Tanzania, United Republic of
  4. 4 Ifakara Health Institute, Ifakara, Tanzania, United Republic of
  5. 5 McGill University Faculty of Medicine and Health Sciences, Montreal, Quebec, Canada
  6. 6 Institute for Health and Social Policy and Department of Epidemiology, Biostatistics, and Occupational Health, McGill University Faculty of Medicine and Health Sciences, Montreal, Quebec, Canada
  1. Correspondence to .Dr. Erin Hetherington, Department of Epidemioligy, Biostatistics, and Occupational Health, McGill University Faculty of Medicine and Health Sciences, Montreal, Canada; erin.hetherington{at}mail.mcgill.ca

Abstract

Background The Tabora Maternal and Newborn Health Initiative project was a multicomponent intervention to improve maternal and newborn health in the Tabora region of Tanzania. Components included training healthcare providers and community health workers, infrastructure upgrades, and improvements to health management. This study aimed to examine the impact of trainings on four key outcomes: skilled birth attendance, antenatal care, respectful maternity care and patient–provider communication.

Methods Trainings were delivered sequentially at four time points between 2018 and 2019 in eight districts (two districts at a time). Cross-sectional surveys were administered to a random sample of households in all districts at baseline and after each training wave. Due to practical necessities, the original stepped wedge cluster randomised design of the evaluation was altered mid-programme. Therefore, a difference-in-differences for multiple groups in multiple periods was adopted to compare outcomes in treated districts to not yet treated districts. Risk differences were estimated for the overall average treatment effect on the treated and group/time dynamic effects.

Results Respondents reported 3895 deliveries over the course of the study. The intervention was associated with a 12.9 percentage point increase in skilled birth attendance (95% CI 0.4 to 25.4), which began to increase 4 months after the end of training in each district. There was little evidence of impact on antenatal care visits, respectful treatment during delivery and patient–provider communication.

Conclusion Interventions to train local healthcare workers in basic and comprehensive emergency obstetric and newborn care increased skilled birth attendance but had limited impact on other pregnancy-related outcomes.

  • MATERNAL HEALTH
  • CHILD HEALTH
  • INTERNATIONAL HEALTH
  • HEALTH POLICY
  • METHODS

Data availability statement

Data are available in a public, open access repository.

https://doi.org/10.1136/jech-2022-219995

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    Data availability statement

    Data are available in a public, open access repository.

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    Footnotes

    • Twitter @elhether, @sbh4th

    • Contributors AN, SH and RD developed the research question, conceptualised the study design and oversaw thestudy protocol development and implementation. SM and CF supported the implementation of thestudy protocol and local management and monitoring of the study. EH, IV and SH were responsible fordata management and data analysis. EH and SH wrote the initial draft of the paper with input from SM, CF, RD, NL, CT, IV and AN. SH is the guarantor. All authors reviewed the manuscript for important intellectual content, contributed to the interpretation and revision of the manuscript, and approved the final draft.

    • Funding Funding awarded by the Government of Canada (Global Affairs Canada) to CARE Canada for the project, 'Improving maternal and newborn health in underserved areas in Tanzania.'

    • Competing interests None declared.

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.