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Papers by Dr. Sunday Dominico

Research paper thumbnail of A research agenda to improve incidence and outcomes of assisted vaginal birth

Bulletin of the World Health Organization

Research paper thumbnail of Individual, Community, and Health Facility Predictors of Postnatal Care Utilization in Rural Tanzania: A Multilevel Analysis

Global Health: Science and Practice

Coverage for postnatal care (PNC) in a remote, mostly rural region of Tanzania was low, with 5 of... more Coverage for postnatal care (PNC) in a remote, mostly rural region of Tanzania was low, with 5 of 6 women not using facility-based postnatal checkups. n Controlling for all other factors, we found that several individual and community characteristics were associated with PNC, including decisionmaking autonomy, presence of a birth companion for support during labor and delivery, cesarean delivery, district of residence, and presence of an adequate health facility within 5 km travel distance. n Increasing the use of PNC services would require improving the adequacy of care in proximal health facilities, empowering women to use preventive services, and increasing women's and communities' birth preparedness.

Research paper thumbnail of Mean monthly deliveries before and after introduction of CEmONC services in WLF supported health centres

<p>Mean monthly deliveries before and after introduction of CEmONC services in WLF supporte... more <p>Mean monthly deliveries before and after introduction of CEmONC services in WLF supported health centres.</p

Research paper thumbnail of Patient and provider determinants for receipt of three dimensions of respectful maternity care in Kigoma Region, Tanzania-April-July, 2016

Reproductive Health, 2018

Research paper thumbnail of Context Matters: Strategies to Improve Maternal and Newborn Health Services in Sub-Saharan Africa

Global health, science and practice, Apr 28, 2022

Research paper thumbnail of Overtime trends of referral rates before and after introduction of CEmONC services in WLF supported health centres based on regions

<p>Overtime trends of referral rates before and after introduction of CEmONC services in WL... more <p>Overtime trends of referral rates before and after introduction of CEmONC services in WLF supported health centres based on regions.</p

Research paper thumbnail of Improving Experience of Labour and Delivery Care Through Birth Companionship: Findings from A Qualitative Study on A Pilot Birth Companionship Project in Kigoma, Tanzania

AIJR Abstracts, Jul 24, 2021

Research paper thumbnail of Acceptability and Satisfaction of Birth Companionship Among Health Providers and Clients in Rural Public Health Facilities in Kigoma, Western Tanzania

AIJR Abstracts, Jul 24, 2021

Research paper thumbnail of Factors and causes of maternal, intrapartum and very early neonatal deaths in WLF project supported health facilities

<p>Factors and causes of maternal, intrapartum and very early neonatal deaths in WLF projec... more <p>Factors and causes of maternal, intrapartum and very early neonatal deaths in WLF project supported health facilities.</p

Research paper thumbnail of Population based C-section rate after introducing CEmONC services in health facilities under WLF support

<p>Population based C-section rate after introducing CEmONC services in health facilities u... more <p>Population based C-section rate after introducing CEmONC services in health facilities under WLF support.</p

Research paper thumbnail of Case fatality rates in WLF project supported CEmONC health facilities

<p>Case fatality rates in WLF project supported CEmONC health facilities.</p

Research paper thumbnail of Factors related to the practice of vacuum-assisted birth: findings from provider interviews in Kigoma, Tanzania

BMC Pregnancy and Childbirth

Background Vacuum-assisted birth is not widely practiced in Tanzania but efforts to re-introduce ... more Background Vacuum-assisted birth is not widely practiced in Tanzania but efforts to re-introduce the procedure suggest some success. Few studies have targeted childbirth attendants to learn how their perceptions of and training experiences with the procedure affect practice. This study explores a largely rural cohort of health providers to determine associations between recent practice of the procedure and training, individual and contextual factors. Methods A cross-sectional knowledge, attitudes and practice survey of 297 providers was conducted in 2019 at 3 hospitals and 12 health centers that provided comprehensive emergency obstetric care. We used descriptive statistics and binary logistic regression to model the probability of having performed a vacuum extraction in the last 3 months. Results Providers were roughly split between working in maternity units in hospitals and health centers. They included: medical doctors, assistant medical officers (14%); clinical officers (10%); ...

Research paper thumbnail of A Comprehensive Approach to Improving Emergency Obstetric and Newborn Care in Kigoma, Tanzania

Global Health: Science and Practice

Research paper thumbnail of Context Matters: Strategies to Improve Maternal and Newborn Health Services in Sub-Saharan Africa

Global Health: Science and Practice

Research paper thumbnail of Timeline for facility construction and introduction of CEmONC services in WLF Supported Health Facilities

<p>Timeline for facility construction and introduction of CEmONC services in WLF Supported ... more <p>Timeline for facility construction and introduction of CEmONC services in WLF Supported Health Facilities.</p

Research paper thumbnail of Selected Findings from Pilot Birth Companionship in Kigoma on the Contribution of Continuous Emotional Support Through Birth Companionship in Increasing Facility Delivery and Improving Maternal and Newborn Outcomes

AIJR Abstracts, Jul 24, 2021

Research paper thumbnail of Additional file 1 of Birth companionship in a government health system: a pilot study in Kigoma, Tanzania

Research paper thumbnail of Additional file 1 of Factors related to the practice of vacuum-assisted birth: findings from provider interviews in Kigoma, Tanzania

Additional file 1. *Knowledge, Attitudes and Practice (KAP) survey questionnaire for providers&#3... more Additional file 1. *Knowledge, Attitudes and Practice (KAP) survey questionnaire for providers' interviews on vacuum assisted birth in 15 public facilities in Kigoma, Tanzania.

Research paper thumbnail of Reintroducing vacuum extraction in primary health care facilities: a case study from Tanzania

BMC Pregnancy and Childbirth, 2018

Background: In rural Tanzania access to emergency obstetric and newborn care is threatened by poo... more Background: In rural Tanzania access to emergency obstetric and newborn care is threatened by poor roads and understaffed facilities among other challenges. Districts in Kigoma, Pwani and Morogoro regions were targeted by a local non-governmental organization to assist local government to build capacity and improve access to clinical management of severe obstetric and newborn complications. The program upgraded ten primary health care centres to provide comprehensive emergency obstetric and newborn care. This paper describes the process of reintroducing vacuum extraction into ten health centres and five hospitals, highlighting patterns in uptake, mode of delivery and lessons learned. Methods: This observational study uses facility-based trend data collected between 2011 and 2016.Descriptive outcomes include institutional caesarean delivery rates, vacuum extraction rates, and the ratio of caesareans to vacuum-assisted deliveries. Results: Institutional caesarean delivery rates remained stable at about 10-11% and the vacuum extraction rate rose from virtually no procedures in 2011 to about 2% in 2016. The increase was more visible in upgraded health centres than in hospitals. In 2016 vacuum extraction rates in newly upgraded health centres ranged from 0.5 to 7. 8%. Between 2011 and 2016, the ratio of caesareans to vacuum extractions in hospitals changed from 304 caesareans to 1 vacuum extraction to 10:1, while in health centres the ratio changed from 22: 1 to 3: 1. Conclusions: Reintroduction of vacuum extraction into clinical practice in primary health care facilities with taskshifting is feasible. Reintroduction of this procedure was more successful when part of an integrated upgrading of health centres to provide comprehensive emergency obstetric care than when reintroduced into busy hospital environments. Turnover of trained staff in hospitals contributed to the uneven uptake of vacuum extraction. Lessons learned are applicable to further national scale up and to other countries.

Research paper thumbnail of Introducing eHealth strategies to enhance maternal and perinatal health care in rural Tanzania

Maternal Health, Neonatology and Perinatology, 2017

Background: Globally, eHealth has attracted considerable attention as a means of supporting mater... more Background: Globally, eHealth has attracted considerable attention as a means of supporting maternal and perinatal health care. This article describes best practices, gains and challenges of implementing eHealth for maternal and perinatal health care in extremely remote and rural Tanzania. Methods: Teleconsultation for obstetric emergency care, audio teleconferences and online eLearning systems were installed in ten upgraded rural health centres, four rural district hospitals and one regional hospital in Tanzania. Uptake of teleconsultation and teleconference platforms were evaluated retrospectively. A cross sectional descriptive study design was applied to assess performance and adoption of eLearning. Results: In 2015 a total of 38 teleconsultations were attended by consultant obstetricians and 33 teleconferences were conducted and attended by 40 health care providers from 14 facilities. A total of 240 clinical cases mainly caesarean sections (CS), maternal and perinatal morbidities and mortalities were discussed and recommendations for improvement were provided. Four modules were hosted and 43 care providers were registered on the eLearning system. For a period of 18-21 months total views on the site, weekly conference forum, chatroom and learning resources ranged between 106 and 1,438. Completion of learning modules, acknowledgment of having acquired and utilized new knowledge and skills in clinical practice were reported in 43-89% of 20 interviewed health care providers. Competencies in using the eLearning system were demonstrated in 62% of the targeted users. Conclusions: E-Health presents an opportunity for improving maternal health care in underserved remote areas in low-resource settings by broadening knowledge and skills, and by connecting frontline care providers with consultants for emergency teleconsultations.

Research paper thumbnail of A research agenda to improve incidence and outcomes of assisted vaginal birth

Bulletin of the World Health Organization

Research paper thumbnail of Individual, Community, and Health Facility Predictors of Postnatal Care Utilization in Rural Tanzania: A Multilevel Analysis

Global Health: Science and Practice

Coverage for postnatal care (PNC) in a remote, mostly rural region of Tanzania was low, with 5 of... more Coverage for postnatal care (PNC) in a remote, mostly rural region of Tanzania was low, with 5 of 6 women not using facility-based postnatal checkups. n Controlling for all other factors, we found that several individual and community characteristics were associated with PNC, including decisionmaking autonomy, presence of a birth companion for support during labor and delivery, cesarean delivery, district of residence, and presence of an adequate health facility within 5 km travel distance. n Increasing the use of PNC services would require improving the adequacy of care in proximal health facilities, empowering women to use preventive services, and increasing women's and communities' birth preparedness.

Research paper thumbnail of Mean monthly deliveries before and after introduction of CEmONC services in WLF supported health centres

<p>Mean monthly deliveries before and after introduction of CEmONC services in WLF supporte... more <p>Mean monthly deliveries before and after introduction of CEmONC services in WLF supported health centres.</p

Research paper thumbnail of Patient and provider determinants for receipt of three dimensions of respectful maternity care in Kigoma Region, Tanzania-April-July, 2016

Reproductive Health, 2018

Research paper thumbnail of Context Matters: Strategies to Improve Maternal and Newborn Health Services in Sub-Saharan Africa

Global health, science and practice, Apr 28, 2022

Research paper thumbnail of Overtime trends of referral rates before and after introduction of CEmONC services in WLF supported health centres based on regions

<p>Overtime trends of referral rates before and after introduction of CEmONC services in WL... more <p>Overtime trends of referral rates before and after introduction of CEmONC services in WLF supported health centres based on regions.</p

Research paper thumbnail of Improving Experience of Labour and Delivery Care Through Birth Companionship: Findings from A Qualitative Study on A Pilot Birth Companionship Project in Kigoma, Tanzania

AIJR Abstracts, Jul 24, 2021

Research paper thumbnail of Acceptability and Satisfaction of Birth Companionship Among Health Providers and Clients in Rural Public Health Facilities in Kigoma, Western Tanzania

AIJR Abstracts, Jul 24, 2021

Research paper thumbnail of Factors and causes of maternal, intrapartum and very early neonatal deaths in WLF project supported health facilities

<p>Factors and causes of maternal, intrapartum and very early neonatal deaths in WLF projec... more <p>Factors and causes of maternal, intrapartum and very early neonatal deaths in WLF project supported health facilities.</p

Research paper thumbnail of Population based C-section rate after introducing CEmONC services in health facilities under WLF support

<p>Population based C-section rate after introducing CEmONC services in health facilities u... more <p>Population based C-section rate after introducing CEmONC services in health facilities under WLF support.</p

Research paper thumbnail of Case fatality rates in WLF project supported CEmONC health facilities

<p>Case fatality rates in WLF project supported CEmONC health facilities.</p

Research paper thumbnail of Factors related to the practice of vacuum-assisted birth: findings from provider interviews in Kigoma, Tanzania

BMC Pregnancy and Childbirth

Background Vacuum-assisted birth is not widely practiced in Tanzania but efforts to re-introduce ... more Background Vacuum-assisted birth is not widely practiced in Tanzania but efforts to re-introduce the procedure suggest some success. Few studies have targeted childbirth attendants to learn how their perceptions of and training experiences with the procedure affect practice. This study explores a largely rural cohort of health providers to determine associations between recent practice of the procedure and training, individual and contextual factors. Methods A cross-sectional knowledge, attitudes and practice survey of 297 providers was conducted in 2019 at 3 hospitals and 12 health centers that provided comprehensive emergency obstetric care. We used descriptive statistics and binary logistic regression to model the probability of having performed a vacuum extraction in the last 3 months. Results Providers were roughly split between working in maternity units in hospitals and health centers. They included: medical doctors, assistant medical officers (14%); clinical officers (10%); ...

Research paper thumbnail of A Comprehensive Approach to Improving Emergency Obstetric and Newborn Care in Kigoma, Tanzania

Global Health: Science and Practice

Research paper thumbnail of Context Matters: Strategies to Improve Maternal and Newborn Health Services in Sub-Saharan Africa

Global Health: Science and Practice

Research paper thumbnail of Timeline for facility construction and introduction of CEmONC services in WLF Supported Health Facilities

<p>Timeline for facility construction and introduction of CEmONC services in WLF Supported ... more <p>Timeline for facility construction and introduction of CEmONC services in WLF Supported Health Facilities.</p

Research paper thumbnail of Selected Findings from Pilot Birth Companionship in Kigoma on the Contribution of Continuous Emotional Support Through Birth Companionship in Increasing Facility Delivery and Improving Maternal and Newborn Outcomes

AIJR Abstracts, Jul 24, 2021

Research paper thumbnail of Additional file 1 of Birth companionship in a government health system: a pilot study in Kigoma, Tanzania

Research paper thumbnail of Additional file 1 of Factors related to the practice of vacuum-assisted birth: findings from provider interviews in Kigoma, Tanzania

Additional file 1. *Knowledge, Attitudes and Practice (KAP) survey questionnaire for providers&#3... more Additional file 1. *Knowledge, Attitudes and Practice (KAP) survey questionnaire for providers' interviews on vacuum assisted birth in 15 public facilities in Kigoma, Tanzania.

Research paper thumbnail of Reintroducing vacuum extraction in primary health care facilities: a case study from Tanzania

BMC Pregnancy and Childbirth, 2018

Background: In rural Tanzania access to emergency obstetric and newborn care is threatened by poo... more Background: In rural Tanzania access to emergency obstetric and newborn care is threatened by poor roads and understaffed facilities among other challenges. Districts in Kigoma, Pwani and Morogoro regions were targeted by a local non-governmental organization to assist local government to build capacity and improve access to clinical management of severe obstetric and newborn complications. The program upgraded ten primary health care centres to provide comprehensive emergency obstetric and newborn care. This paper describes the process of reintroducing vacuum extraction into ten health centres and five hospitals, highlighting patterns in uptake, mode of delivery and lessons learned. Methods: This observational study uses facility-based trend data collected between 2011 and 2016.Descriptive outcomes include institutional caesarean delivery rates, vacuum extraction rates, and the ratio of caesareans to vacuum-assisted deliveries. Results: Institutional caesarean delivery rates remained stable at about 10-11% and the vacuum extraction rate rose from virtually no procedures in 2011 to about 2% in 2016. The increase was more visible in upgraded health centres than in hospitals. In 2016 vacuum extraction rates in newly upgraded health centres ranged from 0.5 to 7. 8%. Between 2011 and 2016, the ratio of caesareans to vacuum extractions in hospitals changed from 304 caesareans to 1 vacuum extraction to 10:1, while in health centres the ratio changed from 22: 1 to 3: 1. Conclusions: Reintroduction of vacuum extraction into clinical practice in primary health care facilities with taskshifting is feasible. Reintroduction of this procedure was more successful when part of an integrated upgrading of health centres to provide comprehensive emergency obstetric care than when reintroduced into busy hospital environments. Turnover of trained staff in hospitals contributed to the uneven uptake of vacuum extraction. Lessons learned are applicable to further national scale up and to other countries.

Research paper thumbnail of Introducing eHealth strategies to enhance maternal and perinatal health care in rural Tanzania

Maternal Health, Neonatology and Perinatology, 2017

Background: Globally, eHealth has attracted considerable attention as a means of supporting mater... more Background: Globally, eHealth has attracted considerable attention as a means of supporting maternal and perinatal health care. This article describes best practices, gains and challenges of implementing eHealth for maternal and perinatal health care in extremely remote and rural Tanzania. Methods: Teleconsultation for obstetric emergency care, audio teleconferences and online eLearning systems were installed in ten upgraded rural health centres, four rural district hospitals and one regional hospital in Tanzania. Uptake of teleconsultation and teleconference platforms were evaluated retrospectively. A cross sectional descriptive study design was applied to assess performance and adoption of eLearning. Results: In 2015 a total of 38 teleconsultations were attended by consultant obstetricians and 33 teleconferences were conducted and attended by 40 health care providers from 14 facilities. A total of 240 clinical cases mainly caesarean sections (CS), maternal and perinatal morbidities and mortalities were discussed and recommendations for improvement were provided. Four modules were hosted and 43 care providers were registered on the eLearning system. For a period of 18-21 months total views on the site, weekly conference forum, chatroom and learning resources ranged between 106 and 1,438. Completion of learning modules, acknowledgment of having acquired and utilized new knowledge and skills in clinical practice were reported in 43-89% of 20 interviewed health care providers. Competencies in using the eLearning system were demonstrated in 62% of the targeted users. Conclusions: E-Health presents an opportunity for improving maternal health care in underserved remote areas in low-resource settings by broadening knowledge and skills, and by connecting frontline care providers with consultants for emergency teleconsultations.