Detection and management of obstetric risk factors among pregnant women attending maternal and child health care clinics in Musoma rural district

Maternal mortality remains a major public health problem in Tanzania. The Safe Motherhood Initiative was adopted in 1989, as a comprehensive strategy to improve the quality of maternal health care and ultimately reduce maternal mortality rate by 50% by the year 2000. The aim of this study was to assess the detection and management of obstetric risk factors among pregnant women attending rural MCH clinics in Musoma Rural District; also to determine the quality of antenatal care provided by health workers in rural areas and pregnant women's ability to afford transport costs if referred to a hospital. A total of 478 pregnant women attending ten antenatal clinics in Musoma Rural District were identified between July and September 1991. Pregnant women were examined by staff in MCH clinics, then they were re-examined by a research team, using MCH-4 card, to counter check the findings and management provided. All clients were then asked if they could afford to pay transport costs to a referral hospital. The results showed that about 27.0% (129/478) of the pregnancies had one or more obstetric risk factor(s). About 75% of the at-risk pregnancies could be detected by health workers and less than, two thirds (57.7%) were properly managed. The ability to detect and manage at-risk pregnancies was better among trained staff than the untrained. Adequacy of equipment in a unit appeared to significantly increase the detection rate of at-risk pregnancies. Only half of the women could afford transport costs to a hospital. These findings suggest that the quality of antenatal care in the district needs improvement by proper history taking and physical examination at peripheral level. Health workers should be provided with on the job training, more frequent supervision and essential equipment to enable them deliver better maternal care. Similarly, villagers should make transport available to referred pregnant women.