Implications of using assistant medical officers to perform caesarean sections on maternal and neonatal outcomes in the context of task sharing practice at selected secondary and primary health facilities in Tanzania

Abstract

Background: Fifty-six years ago, Tanzania introduced Assistant Medical Officers (AMOs), capable of providing health services which might be performed by Medical Doctors (MDs) at primary and secondary level of care. For the purpose of this study, the primary and secondary health facilities refer to Health centres and district hospital/ Designated District Hospitals respectively. Since the country established the task sharing policy in recent years, the success rate of caesarean sections (C-sections) performed by AMOs and the maternal and neonatal outcomes, have not been systematically evaluated in the country.

Objective: To assess the contribution of AMOs in performing C-sections and maternal and neonatal outcomes in primary and secondary health facilities in Tanzania.

Design: A cross sectional retrospective study Setting: Three secondary and 3 primary health facilities in Kigoma, Morogoro, Mtwara and Tanga regions, Tanzania.

Subjects: Four thousand, three hundred and two (4302) clinical records of Csections conducted between 1st January 2014 and 31st December 2015. Data analysis was done using IBM SPSS software package.

Results: AMOs were more likely than MDs to perform elective C-sections at selected health centers and district hospitals than emergency C-sections, OR=2.52 95% CI (1.80 - 3.54); AMOs were more likely than MDs to report big baby-small maternal pelvis indications than foetal distress, OR = 1.35 95%CI (1.01 – 1.81). In both univariable and multivariable analysis, there was no statistical difference between AMO and MDs on outcome of the baby and post-operative complications.

Conclusion: In this study setting, maternal and neonatal outcomes of C-sections performed by AMOs compared well with those performed by MDs. Therefore, there is a clear policy implication to consider more efforts to improve quality and outcomes with awareness of the fact that more women can access C-section services through task sharing strategy.