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Low use of vacuum extraction: Health care Professionals' Perspective in a University Hospital, Dar es Salaam
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, International Maternal and Child Health (IMCH), International Maternal and Reproductive Health and Migration.ORCID iD: 0000-0002-7816-9071
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, International Maternal and Child Health (IMCH), International Maternal and Reproductive Health and Migration. Muhimbili Univ Hlth & Allied Sci, POB 65001, Dar Es Salaam, Tanzania..ORCID iD: 0000-0003-3854-9085
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, International Maternal and Child Health (IMCH), International Maternal and Reproductive Health and Migration.
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, International Maternal and Child Health (IMCH), Global Health Research on Implementation and Sustainability.ORCID iD: 0000-0001-7164-598x
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2020 (English)In: Sexual & Reproductive HealthCare, ISSN 1877-5756, E-ISSN 1877-5764, Vol. 25, article id 100533Article in journal (Refereed) Published
Abstract [en]

Background: Use of vacuum extraction (VE) has been declining in low and middle income countries. At the highest referral hospital Tanzania, 54% of deliveries are performed by caesarean section (CS) and only 0.8% by VE. Use of VE has the potential to reduce CS rates and improve maternal and neonatal outcomes but causes for its low use is not fully explored.

Method: During November and December of 2017 participatory observations, semi-structured in-depth interviews (n = 29) and focus group discussions (n = 2) were held with midwives, residents and specialists working at the highest referral hospital in Tanzania. Thematic analysis was used to identify rationales for low VE use.

Findings: Unstructured and inconsistent clinical teaching structure, interdependent on a fear and blame culture, as well as financial incentives and a lack of structured, adhered to and updated guidelines were identified as rationales for CS instead of VE use. Although all informants showed positivity towards clinical teaching of VE, a subpar communication between clinics and academia was stated as resulting in absent clinical teachers and unaccountable students.

Conclusion: This study draws connections between the low use of VE and the inconsistent and unstructured clinical training of VE expressed through the health care providers' points of view. However, clinical teaching in VE was highly welcomed by the informers which may serve as a good starting point for future interventions.

Place, publisher, year, edition, pages
ELSEVIER IRELAND LTD , 2020. Vol. 25, article id 100533
Keywords [en]
Vacuum extraction, Caesarean section, Tanzania, Low-income setting
National Category
Nursing Obstetrics, Gynecology and Reproductive Medicine Public Health, Global Health, Social Medicine and Epidemiology
Identifiers
URN: urn:nbn:se:uu:diva-424042DOI: 10.1016/j.srhc.2020.100533ISI: 000577442600003PubMedID: 32505920OAI: oai:DiVA.org:uu-424042DiVA, id: diva2:1485478
Available from: 2020-11-02 Created: 2020-11-02 Last updated: 2020-11-02Bibliographically approved

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Makokha-Sandell, HenrikMgaya, AndrewBelachew, JohannaLitorp, HelenaKidanto, Hussein L.Essén, Birgitta

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NursingObstetrics, Gynecology and Reproductive MedicinePublic Health, Global Health, Social Medicine and Epidemiology

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