Three case studies and experiences of maternal death at a regional referral hospital in Rukwa, Tanzania

In this chapter, we discuss and analyze three cases of maternal death that occurred at the Sumbawanga Regional Referral Hospital in 2014. Through the discussion of these cases we seek to identify gaps in maternal health care in the region, and how these affect the women’s conditions and the care women receive when they reach the hospital. Even at this regional hospital, which is the highest-level facility in this region of more than 1 million people, there are gaps in maternity care provision. These include: insufficient knowledge and skills on the part of the providers, lack of supplies, including necessary drugs and specialized investigations to help with diagnosis and planning of appropriate treatment, and adequate facilities for investigating, monitoring, and managing critical cases. Even with increased provider training, some aspects of maternal care do not improve due to other infrastructural challenges, which can contribute to poor maternal health outcomes. Through our analysis of these cases, we seek to produce recommendations for methods to bridge these gaps. These include quarterly and monthly outreach to remote areas of the region, better availability of transportation at all dispensaries, and creation of a dedicated training program for the Rukwa Region to improve the quality of providers at dispensaries, the lowest level of care. Regional
Hospital staff may need specific training to increase their ability to manage critical cases, including further training in intensive care and emergency obstetric care. The cases reveal that the hospital also needs to better equip both the intensive care unit and the hospital in general, in order to facilitate early detection of problems during pregnancy and birth. We hope our analysis and recommendations from experience working in the Rukwa Region can aid other providers in their efforts to identify gaps in maternal health care and to begin to construct ways to bridge gaps in their settings.