Cooperation can improve maternity care

New doctor Andrew Mgaya (in the middle) has had two supervisors: Hussein Kidanto in Dar es Salaam and Birgitta Essén in Uppsala.

The use of caesarean sections has shot through the roof at Muhimbili National Hospital in Tanzania, increasing the risk of complications. Researchers have developed a method to improve maternity care in close cooperation between Uppsala and Dar es Salaam.

Working in teams and getting the staff involved – midwives, doctors and others – has proven to be a recipe for success in reversing the trend of growing numbers of C-sections. With the help of clinical evaluations and various measures, maternity care has improved, according to a study by Andrew Mgaya.
He was in Uppsala in May 2017 to present his thesis. Joining him on the trip was his supervisor Hussein Kidanto, who works at the Ministry of Health and Family Welfare in Dar es Salaam and who himself earned his PhD in Sweden in 2009. The cooperation has continued ever since.

“It involves both research and education in cooperation between a low-income country and a high-income country. It’s a mutual exchange of knowledge between our two universities,” says Hussein Kidanto.

He visits the Department of Women’s and Children’s Health in Uppsala at least twice a year.

“When I come here, I also lecture Master’s students, who then visit us in Tanzania. This is a chain that I hope will never be broken.”

Educated in both Sweden and Tanzania

The research students attend a so-called sandwich programme and are educated in both Uppsala and Dar-es-Salaam. Andrew Mgaya therefore also has a supervisor at Uppsala University, Professor Birgitta Essén.

“This is the second thesis on C-sections,” she explains. “Now, a third doctoral student will make a new intervention to improve maternity care from a different angle, reducing maternal mortality and foetal mortality.”

She explains that she and her research team are developing techniques and tools for care providers in Tanzania.

“Ultimately, it’s very much a matter of increasing knowledge on site. As researchers, we see certain problems, find new knowledge and then let the healthcare personnel themselves work on how the care can be improved.”

Developing a creative group

The approach demands continuity and the research team has successfully achieved it. Hussein Kidanto has continued to research and teach, for example.

“It’s not enough to pursue doctoral studies, you have to continue after the PhD to develop a creative, sustainable group that can train teachers and staff and suggest new improvement ideas,” says Birgitta Essén.

She emphasises that the exchange of knowledge is just as important for Uppsala University, not least through the newly established Forum for Africa Studies, which gathers researchers in various subject areas. Doctor Kidanto regularly comes here and teaches master’s students in global reproductive health.

“I teach about the healthcare system in Tanzania so that they can compare the healthcare system in Sweden with low-income countries, but they also see the obstacles that exist to fighting diseases from a global perspective,” he says.

Caesarean section is a risk factor

When it comes to research about maternity care, there are special challenges. One is the increasing use of caesarean sections, which is a serious risk factor for both the mother and the child. In Tanzania, 5 per cent of deliveries are done by C-section, but at the Muhimbili hospital, the figure is ten times higher – a full 50 per cent.

“Up to an acceptable level, it’s OK, but when many incorrect C-sections are done, it leads to more complications that can be deadly. The use of C-sections must therefore be limited. Women who need it should be operated on and those who can deliver naturally should do so,” says Andrew Mgaya.

In working on the thesis, he tested involving the care staff in clinical reviews and improvement measures. In the course of the study, the diagnosis of impending hypoxia and unrealised progress, which are the two most common causes of C-sections, improved. Medical care prior to a C-section was also improved.

Women are afraid of complications

An earlier thesis by Helena Litorp, who spent six months at the hospital in Dar es Salaam, shows that it is rarely the women themselves who want a C-section.

“They are afraid of complications. In Sweden, it’s safer than in Tanzania because of better medical resources while a Tanzanian woman who requests a C-section knows that it’s a life-threatening procedure. Many of them talk about postoperative pain and complications. Most ask to give birth naturally,” says Andrew Mgaya.

The same is true of women in Rwanda, Uganda and Somalia, according to Birgitta Essén.

“Our research team has been able to show why women from Tanzania or Somalia who come to Sweden sometimes refuse a C-section even when it’s acute to save the foetus. This is one example of why it’s good for Swedes to learn something about the African context.”

She explains that Uppsala University Hospital is participating in the new doctoral student study that has begun. There is a lot to learn for Swedish healthcare.

“The global research results can be applied not only in Tanzania, but also in Sweden, in a globalised world with migration and refugees from around the world.”



International Maternal and Reproductive Health is a research team at the International Maternal and Child Health unit (IMCH) of the Department of Women’s and Children’s Health at Uppsala University. The team collaborates with researchers in the rest of Europe, Asia, Latin America and Africa. The objective is to develop practical solutions and scientific methods for healthcare staff and decision makers that can improve global sexual and reproductive health in various countries.

17 October 2017