Lilian Mselle | Muhimbili University of Health and Allied Sciences (MUHAS) (original) (raw)

Papers by Lilian Mselle

Research Square (Research Square), Jan 8, 2021

Background: Training of mid-level providers is a task-sharing strategy that has gained popularity... more Background: Training of mid-level providers is a task-sharing strategy that has gained popularity in the recent past for addressing the critical shortage of the health workforce. In Tanzania, training of mid-level providers has existed for over ve decades; however, concerns exist regarding the quality of mid-level cadres amidst the growing number of medical universities. This study sought to explore the challenges facing the Assistant Medical O cers training for the performance of Caesarean section delivery in Tanzania. Methods: An exploratory qualitative case study was carried out in four regions to include one rural district in each of the selected regions and two AMO training colleges in Tanzania. A semi-structured interview guide was used to interview 29 key informants from the district hospitals, district management, regional management, AMO training college, and one retired AMO. Also, four focus group discussions were conducted with 35 AMO trainees. Results: Training of AMOs in Tanzania faces many challenges. The challenges include: use of outdated and static curriculum, inadequate tutors (lack of teaching skills and experience of teaching adults), inadequate teaching infrastructure in the existence of many other trainees, including interns, and limited or lack of scholarships and sponsorship for the AMO trainees. Conclusions: The ndings of this study underscore that the challenges facing AMO training for the performance of Caesarean section delivery have the potential to negatively impact the quality of Caesarean sections performed by this cadre. A holistic approach is needed in addressing these challenges. The solutions should focus on reviewing the curriculum, deploying quali ed tutors, and improving the competencies of the available tutors through continuing medical education programmes. Furthermore, the government in collaboration with other stakeholders should work together to address the challenges in teaching infrastructure and providing nancial support to this cadre that has continued to be the backbone of primary healthcare in Tanzania. Long-term solutions should consider deploying medical o cers at the primary facilities and phasing out the performance of Caesarean section by AMOs.

PLOS ONE, Jun 14, 2023

Background The advantages of caesarean section (CS) in managing obstetric emergencies are abundan... more Background The advantages of caesarean section (CS) in managing obstetric emergencies are abundant, but it is associated with several complications including surgical site infection (SSI). SSI significantly contributes to maternal morbidity and mortality rates. Mothers often do not receive adequate information about their at-home post-delivery care. Also, guidelines on post-CS care worldwide typically do not include home care recommendations. Because of the increased rate of CS and space constraints in the hospitals, mothers are often discharged home within 48 hours after CS. Therefore, it is anticipated that using an evidencebased home care guide would provide instruction to the mothers and is likely to prevent postpartum complications and promote the well-being of both the mother and the newborn. Aim To design and test the effectiveness of a post-CS home care guide in preventing SSI in central Tanzania. Methodology This is a sequential exploratory mixed-method interventional study conducted in two regional referral hospitals in central Tanzania. A qualitative study will be conducted to explore the experiences of nurse midwives, mothers who had caesarean deliveries and their caretakers regarding the care of mothers and newborns at home. The findings will inform the development of a post-CS home care guide. Following a series of validations of the guide, research assistants will employ the guidelines to instruct post-CS mothers about home care as part of the intervention. Thirty participants will purposively be recruited for the qualitative study and a random sample of 248 nurse-midwives and 414 post-CS mothers to assess the effectiveness of the guide in improving knowledge of home care and preventing

BMC Women's Health, Nov 24, 2015

Background: Obstetric fistula is a worldwide problem that affects women and girls mostly in Sub S... more Background: Obstetric fistula is a worldwide problem that affects women and girls mostly in Sub Saharan Africa. It is a devastating medical condition consisting of an abnormal opening between the vagina and the bladder or rectum, resulting from unrelieved obstructed labour. Obstetric fistula has devastating social, economic and psychological effect on the health and wellbeing of the women living with it. This study aimed at exploring social-cultural experiences of women living with obstetric fistula in rural Tanzania. Methods: Women living with obstetric fistula were identified from the fistula ward at CCBRT hospital. Sixteen individual semi structured interviews and two (2) focus group discussions were conducted among consenting women. Interviews were transcribed verbatim and transcripts analysed independently by two researchers using a thematic analysis approach. Themes related to the experiences of living with obstetric fistula were identified. Results: Four themes illustrating the socio-cultural experiences of women living with obstetric fistula emerged from the analysis of women experiences of living with incontinence and odour. These were keeping clean and neat, earning an income, maintaining marriage, and keeping association. Women experiences of living with fistula were largely influenced by perceptions of people around them basing on their cultural understanding of a woman. Conclusion: Living with fistula reveals women's day-today experiences of social discrimination and loss of control due to incontinence and odour. They cannot work and contribute to the family income, cannot satisfy their husband's sexual needs and or bear children, and cannot interact with members of the community in social activities. Women experience of living with fistula was influenced by perceptions of people around them. In the eyes of these people, women who leak urine were of less value since they were not capable of carrying out ascribed social roles.

Reproductive Health, Jul 22, 2016

Background: Increasing births with skilled attendants and increasing health facilities with Emerg... more Background: Increasing births with skilled attendants and increasing health facilities with Emergency Obstetric Care (EmOC) can reduce maternal mortality and are considered critical interventions for ensuring safe motherhood. Despite Tanzania's policy to support women to give birth with the assistance of skilled personnel, some women do not access this care. This article uses women's stories to illustrate the challenges that caused them to fail to access adequate obstetric care in a timely manner, hence causing the development of fistulas. Methods: This paper presents the narratives of 16 women who were conveniently selected based on their experiences of not being able to access adequate obstetric care in timely manner. The analysis was guided by recommendations for the identification and interpretation of narratives, and identified important components of women's experiences, paying attention to commonalities, differences and areas of emphasis. Semi-structured interviews were carried out at CCBRT hospital in Dar es Salaam. Results: Four (4) general story lines were identified from women description of their inability to access quality obstetric care in a timely manner. These were; failing to decide on a health care facility for delivery, lacking money to get to a health care facility, lacking transportation to a health care facility and lacking quality birth care at the health care facility. Conclusion: Women were unable to reach to the health care facilities providing comprehensive emergency obstetric care (CEmOC) in time because of their lack of decision-making power, money and transportation, and those who did reach the facilities received low quality birth care. Empowering women socially and financially, upgrading primary health care facilities to provide CEmOC and increased numbers of skilled personnel would promote health care facility deliveries.

Research Square (Research Square), Jan 6, 2020

PLOS ONE, Jun 22, 2020

Background Umbilical cord clamping is a crucial step during the third stage of labour that separa... more Background Umbilical cord clamping is a crucial step during the third stage of labour that separates the newborn from the placenta. Despite the available evidence that delayed umbilical cord clamping is more beneficial to infants, as well as the existence of 2014 WHO recommendation that the umbilical cord should be clamped between 1 and 3 minutes, its implementation is still low in many countries including Tanzania. Objective This study describes the experiences and perceptions of nurse-midwives'and obstetricians'about the timing of umbilical cord clamping at a regional referral hospital in Tanzania. Methods A descriptive qualitative study design that adopted a purposeful sampling strategy to recruit 19 participants was used. Nine semi-structured interviews with six nurse-midwives'and three obstetricians', as well as one focus group discussion with ten nurse-midwives'were conducted. Thematic analysis guided the analysis of data. Results Three main themes generated from the data, each having 2 to 5 subthemes. 1. Experiences about the timing of umbilical cord clamping. 2. Perceptions about the umbilical cord clamping. 3. Factors influencing the practice of delayed umbilical cord clamping to improve newborn health outcomes.

Discover Education

Background Health professions training in Tanzania has gradually adopted the competency-based cur... more Background Health professions training in Tanzania has gradually adopted the competency-based curricula (CBC) approach that focuses on learners’ acquisition of competencies in knowledge skills and aptitude. Feedback from the graduates is crucial for improving CBC implementation and review to ensure that graduates acquire clinical competencies and thus improve patient care. Objectives To explore the teaching–learning experiences of medical and nursing graduates during their internship and their supervisors in three teaching hospitals. Methods Exploratory qualitative data from in-depth interviews and focus group discussions were analysed using a content analysis framework. Medical and nursing graduates who were in an internship program in three teaching hospitals in Tanzania were conveniently recruited based on their availability during the data collection period. Results The use of clinical logbooks, guidelines and protocols, bedside teaching, mentorship, and supervision were importa...

International Journal of Women's Health

Background: Antenatal health information enables pregnant women to make informed choices for thei... more Background: Antenatal health information enables pregnant women to make informed choices for their health during pregnancy and childbirth. Worldwide, evidence shows inadequate coverage of the information provided to women during antenatal care visits. Interaction between women and providers is important to ensure effective information exchange. This study aimed to explore women's and nurse midwives' perceptions of their interactions and the information they shared about care during pregnancy and childbirth in Tanzania. Methods: Formative explorative research using in-depth interviews was conducted with eleven Kiswahili-speaking women who had normal pregnancies and had more than three antenatal contacts. Also, five nurse-midwives who worked in the ANC clinic for a year or more were included in the study. A thematic analysis based on descriptive phenomenology guided the analysis of data that was informed by the WHO quality of care framework. Results: Two major themes emerged from the data, enhancing communication and respectful delivery of ANC information and receiving information about pregnancy care and safe childbirth. We found that women felt free to communicate and interact with midwives. Some women feared interacting with midwives and other midwives were difficult to approach. All women acknowledge receiving antenatal care information. However, not all women reported receiving all ANC information as per national and international guidelines. Inadequate staffing and time were the reasons for poor prenatal care information delivery. Conclusion: Women did not report most of the information provided during ANC contacts as per the national ANC guidelines. The inadequate number of nurse-midwives, increased number of clients, and insufficient time were reported to contribute to inadequate provision of information during antenatal care. Strategies for effective provision of information during antenatal contacts should be considered including using group antenatal care and information communication technology. Further, nurse-midwives should be sufficiently deployed and motivated.

BMC Health Services Research

Background Strengthening leadership and management is important for building an effective and eff... more Background Strengthening leadership and management is important for building an effective and efficient health system. This paper presents the findings from a L&M capacity building initiative which was implemented as part of a larger study aimed at improving maternal and newborn outcomes within primary health facilities in the Morogoro, Tanzania. Methods The initiative, involving 30 stakeholders from 20 primary health facilities, 4 council health management teams and the regional health management team in the Morogoro region, provided leadership and managerial training through two 5-day in-person workshops, onsite mentoring, and e-learning modules. The initiative was evaluated using a pre-post design. Quantitative instruments included the ‘Big Results Now’ star-rating assessments and a team-developed survey for health providers/managers. The ‘Big Results Now’ star-rating assessments, conducted in 2018 (19 facilities) and 2021 (20 facilities), measured overall facility leadership and...

Background A diabetic patient is anticipated to follow recommended self-care management to manage... more Background A diabetic patient is anticipated to follow recommended self-care management to manage diabetes properly. Adherence to self-care management is effective in the management of diabetic complications. The aim was to explore barriers to self-management among type 2 diabetes patients at Tigray, Ethiopia, 2020. Method The descriptive qualitative design was used to conduct a study between April and September 2020. Participants were selected purposively to recruit 22 patients with type 2 diabetes, 10 caretakers and health care providers. Data were analyzed thematically and Atlas ti software was used during analysis. Results The reported barriers were Lacking education to cope with the disease, being emotionally disturbed, Failing to adopt new life style, lacking social support, Perceived behavioral control and inadequacy of health care system. Conclusion Type 2 diabetes patients were unable to adhered self-care management due to educational, psychological, social, behavioral and ...

Women and birth : journal of the Australian College of Midwives, Jan 9, 2018

Tanzania has high maternal and neonatal mortality rates. Comprehensive guidelines for postpartum ... more Tanzania has high maternal and neonatal mortality rates. Comprehensive guidelines for postpartum care have been developed by the government as a means to improve health outcomes during the perinatal period. Despite the creation of these guidelines and the government's commitment to universal perinatal care for women and neonates, there is concern that the delivery of postpartum services may not be meeting the needs of mothers and neonates. The purpose of this feminist poststructuralist study was to explore nurse-midwives' and obstetricians' experiences of providing postpartum care in Tanzania. This qualitative study used feminist poststructuralism to explore the personal, social, and institutional discourses of postpartum care. We individually interviewed ten nurse-midwives and three obstetricians in Dar es Salaam, Tanzania. Feminist poststructuralist discourse analysis was used to analyze the transcribed interviews after their translation from Kiswahili to English. Four...

Reproductive Health, 2018

Background: Evidence shows that negative childbirth experiences may lead to undesirable effects i... more Background: Evidence shows that negative childbirth experiences may lead to undesirable effects including failure to breastfeed, reduced love for the baby, emotional upsets, post-traumatic disorders and depression among mothers. Understanding childbirth experiences and their meaning could be important in planning individualized care for mothers. The purpose of this study was to explore childbirth experiences and their meaning among postnatal mothers. Methods: A phenomenological qualitative study was conducted at Mbale Regional Referral Hospital among 25 postnatal mothers within two months after birth using semi-structured interviews and focus group discussions and data was thematically analyzed. Results: The severity, duration and patterns of labour pains were a major concern by almost all women. Women had divergent feelings of yes and no need of biomedical pain relief administration during childbirth. Mothers were socially orientated to regard labour pains as a normal phenomenon regardless of their nature. The health providers' attitudes, care and support gave positive and negative birth experiences. The Physical and psychosocial support provided comfort, consolation and encouragement to the mothers while inappropriate care, poor communication and compromised privacy contributed to the mothers' negative childbirth experiences. The type of birth affected the interpretations of the birth experiences. Women who gave birth vaginally, thought they were strong and brave, determined and self-confident; and were respected by members of their communities. On the contrary, the women who gave birth by operation were culturally considered bewitched, weak and failures. Conclusion: Childbirth experiences were unique; elicited unique feelings, responses and challenges to individual mothers. The findings may be useful in designing interventions that focus on individualized care to meet individual needs and expectations of mothers during childbirth.

American Journal of Health, Medicine and Nursing Practice

Purpose: The purpose of the study is to assess the effects of upright and supine birth positions ... more Purpose: The purpose of the study is to assess the effects of upright and supine birth positions on maternal and new-born outcomes including maternal blood losses, duration of labor, perineum tear or intact, and APGAR score of the new-born in the first and fifth minutes in two District hospitals in Tanzania. Methodology: A quasi-experimental study design using a quantitative approach was conducted to assess the maternal and new-born outcomes in the in intervention study group (upright) and non-intervention group (supine). A convenient sample of 150 parturient were included, among them 73 formed an intervention group and 77 were in the non-intervention group. Data analysis was done using SPSS version 23 whereby STATA software was used to assess the effect of the independent variables (birth positions) to the dependent variables (maternal and new-born outcomes). Results were compared using chi-square test at P-value <0. 05 Findings: Among of women who assumed upright birth position...

Global Maternal and Child Health

Healthcare

Women’s satisfaction has been found to be a good indicator of quality of care and is associated w... more Women’s satisfaction has been found to be a good indicator of quality of care and is associated with the utilization of healthcare services. Women’s needs and satisfaction could be improved through the provision of high-quality antenatal care services. This study assessed women’s expectations of and satisfaction with antenatal care and their associated factors in a semiurban setting in Tanzania. A cross-sectional survey using the Expectations and Satisfaction with the Prenatal Care Questionnaire (PESPC) was used to measure pregnant women’s expectations of and satisfaction with antenatal care in the two districts of Kibaha and Bagamoyo, involving 338 pregnant women. The data were analyzed using SPSS version 26. In the expectation subscale, women had high expectations for personalized care (78.4%), other services (from a social worker and nutritionist) (68.8%), and complete care (being taken care of on time, receiving excellent care, and receiving information without prompting) (60.9%...

Advances in Medical Education and Practice

and Allied Sciences (MUHAS) embarked on structured competency-based curricula (CBC) for its progr... more and Allied Sciences (MUHAS) embarked on structured competency-based curricula (CBC) for its programmes. Other health profession training institutions continued with their traditional way of teaching and thus causing variability in the competencies of the graduates. We aimed to analyze the experiences of different stakeholders on the implementation of CBC specifically on biomedical sciences by MUHAS to inform the development of harmonized competency-based curricula in three health professional training institutions in Tanzania. Methods: We adopted an exploratory case study to analyse the implementation of CBC in programmes of Medicine and Nursing involving MUHAS graduates, immediate supervisors at the employment sites, faculty, and continuing students at MUHAS. Kiswahili guides were used to conduct the in-depth interviews (IDIs) and focus group discussions (FGDs). Qualitative content analysis was adopted for analysis. Results: From the 38 IDIs and 15 FGDs, four categories of human resources teaching and learning environment; curriculum content; and support systems emerged. Human resources were attributed to the shortage of an adequate number of faculty and teaching skills variation. The curriculum content category was linked to the redundancy of courses or topics, poor sequencing of some topics or courses, and limited time for teaching some essential courses or topics. Training and practice area mismatch, accommodation to students, teaching space, and library were the sub-categories linked to teaching and learning environment. Lastly, support systems related to teaching methods and opportunities for improving teaching and learning were revealed. Conclusion: The findings of this study highlight the challenges and opportunities for the implementation of CBC. The solutions to the revealed challenges are beyond the training institutions' capacity. The latter call for multi-stakeholder engagement including those from the public and private sectors in health, higher education and finance for common and sustainable solutions.