Journal of Health and Medical Sciences

ISSN 2622-7258

Published: 06 January 2019

A Situational Analysis of Home Delivery among Maasai Communities of Orkesumet, Northern Tanzania: The Qualitative Evidences

Bernard Mbwele, Uswege K. Mwaitebele, Alem Kahsay, Othniel P. Kihako, Samuel J. Luhunga, Mohamed A. Zuberi, Juhudi R. Athumani, Pauline L. Sylvester, Elinda G. Kuhoga, Zebadia M. Ramadhani, George R. Jonas, Lillian Kavishe

University of Dar es Salaam-Mbeya College of Health Sciences

pdf download

Download Full-Text Pdf

10.31014/aior.1994.02.01.13

Abstract

Background: Maternal mortality rates and Neonatal Mortality rates have remained to be unexpectedly high in sub-Saharan Africa. High magnitude of pregnancy and childbirth complications mainly due to home delivery. Identifying and solving barriers to facility delivery has remained to be a challenge. Methods: A descriptive cross sectional study to assess the cultural barriers impeding facility based delivery in the Maasai communities of Orkesumet ward of Simanjiro district, Northern Tanzania was conducted. Expert opinions from Maasai leaders, in-depth interviews, focused group discussion and observations were applied. Results: Expert opinions presented historical and current traditional practice in herbal medicine commonly used during child-birth in the remote Maasai Orkesumet ward. In-depth interview reported five main themes of “home delivery is safe”, “Traditional medicine is better”, “Giving birth is a blessing from God”, “Bleeding can be controlled by traditional medicine” and “There is no hope from hospitals”. FGD reported four main themes that “Female attendants are better”, “Migration, transport cost and quality of care at health facility disturbs the continuum of care”, “It is risky to be treated at the hospitals” and “Husbands are the key and mislead the communities”. Observations provided evidences for herbal products that are commonly used. Conclusion: The Maasai present a strong trust and beliefs on their cultural, customs and traditional for home delivery while using innovative herbal medicine. They have negative attitudes towards a facility based delivery due to facility reported maternal deaths, quality of care for supplies and hygiene, distance and health care workers gender and attitudes.

References

  1. Adewuyi, EO., Zhao, Y., Auta, A., Lamichhane, R,. (2017). Prevalence and factors associated with non-utilization of healthcare facility for childbirth in rural and urban Nigeria: Analysis of a national population-based survey. Scand J Public Health. 45(6), 675–682.

  2. Amin, M., Willetts, D., Eames J,. (1987). The Last of the Maasai. Camerapix Publishers International.

  3. Atuoye, KN., Amoyaw, JA., Kuuire, VZ, Kangmennaang, J., Boamah, SA., Vercillo, S., Antabe R, McMorris M, Luginaah, I,. (2017). Utilisation of skilled birth attendants over time in Nigeria and Malawi. Global Public Health, 12(6), 728–743.

  4. Bussmann RW, Gilbreath GG, Solio J, Lutura M, Lutuluo R, Kunguru K, Wood N, Mathenge SG,. (2006). Plant use of the Maasai of Sekenani Valley, Maasai Mara, Kenya. J Ethnobiol Ethnomed., 2, 22.

  5. Caulfield, T., Onyo, P., Byrne, A., Nduba, J., Nyagero, J., Morgan, A., & Kermode, M,. (2016). Factors influencing place of delivery for pastoralist women in Kenya: A qualitative study. BMC Women’s Health, 16, 52. 

  6. Sialubanje, C., Massar, K., van der Pijl, MS., Kirch, EM., Hamer, DH., Ruiter, RA,. (2015). Improving access to skilled facility-based delivery services: Women’s beliefs on facilitators and barriers to the utilisation of maternity waiting homes in rural Zambia. Reproductive Health, 12, 61. 

  7. Chege, PM., Kimiywe, JO., Ndungu, ZW,. (2015). Influence of culture on dietary practices of children under five years among Maasai pastoralists in Kajiado, Kenya. Int J Behav Nutr Phys Act., 12, 131.

  8. Davidson, EM., Liu, JJ., Bhopal, R., White, M., Johnson, MRD., Netto, G., Wabnitz, C., Sheikh, A,. (2013). Behavior Change Interventions to Improve the Health of Racial and Ethnic Minority Populations: A Tool Kit of Adaptation Approaches. Milbank Q, 91(4), 811–851.

  9. Doctor, H.V., Nkhana-Salimu, S., & Abdulsalam-Anibilowo, M,. (2018). Health facility delivery in sub-Saharan Africa: Successes, challenges, and implications for the 2030 development agenda. BMC Public Health, 18, 765. 

  10. Ensor, T., Cooper, S,. (2004). Overcoming barriers to health service access: influencing the demand side. Health Policy Plan, 19(2), 69–79.

  11. Forstater M,. (2002). Bones for Sale: ‘development’, environment and food security in East Africa. Review of Political Economy, 14(1), 47–67.

  12. Galvin, KA. Beeton, TA., Boone, RB., BurnSilver, SB,. (2015). Nutritional Status of Maasai Pastoralists under Change. Hum Ecol Interdiscip J, 43(3), 411–424.

  13. Heaney, AK., Winter, SJ,. (2016). Climate-driven migration: an exploratory case study of Maasai health perceptions and help-seeking behaviors. Int J Public Health, 61(6), 641–649.

  14. Ibrahim, F., Barbara, I,. (1998). The Maasai Herbalists in Arusha Town, Tanzania. GeoJournal, 46(2), 141–154.

  15. Fenton, C., Hatfield, J., McIntyre, L,. (2012). A qualitative pilot study of food insecurity among Maasai women in Tanzania. Pan Afr Med J, 12:, 81.

  16. Jennings, C., Falola, T,. (2003). Sources and Methods in African History: Spoken, Written, Unearthed. New York, USA: University of Rochester Press.

  17. Karanja, S., Gichuki, R., Igunza, P., Muhula, S., Ofware, P., Lesiamon, J.,  Leshore, L., Kyomuhangi-Igbodipe, LB., Nyagero J., Binkin N., Ojakaa, D,. (2018). Factors influencing deliveries at health facilities in a rural Maasai Community in Magadi sub-County, Kenya. BMC Pregnancy and Childbirth, 18, 5. 

  18. Kumbani L, Bjune G, Chirwa E, Malata A, Odland JØ,. (2013). Why some women fail to give birth at health facilities: a qualitative study of women’s perceptions of perinatal care from rural Southern Malawi. Reprod Health, 10, 9.

  19. Lawson, DW., Borgerhoff Mulder, M., Ghiselli, ME., Ngadaya, E., Ngowi, B., Mfinanga SG, Hartwig K, James S,. (2014). Ethnicity and child health in northern Tanzania: Maasai pastoralists are disadvantaged compared to neighbouring ethnic groups. PLoS One, 9(10), e110447.

  20. Lennox, J., Petrucka, P., Bassendowski, S,. (2017). Eating practices during pregnancy : perceptions of select Maasai women in Northern Tanzania. Global Health Research and Policy, 2, 9. 

  21. Liu, J., Davidson, E., Bhopal R., White, M., Johnson, M., Netto, G., Deverill, M., Sheikh, A,. (2012). Adapting health promotion interventions to meet the needs of ethnic minority groups: mixed-methods evidence synthesis. Health Technol Assess, 16(44), 1–469.

  22. Magoma, M., Requejo, J., Campbell, OM., Cousens, S., Filippi, V,. (2010). High ANC coverage and low skilled attendance in a rural Tanzanian district: a case for implementing a birth plan intervention. BMC Pregnancy Childbirth., 10, 13.

  23. Martin, A., Blake, C., Bohle, L. F., Bandali, S., Agbon, E., & Hulton, L,. (2016). Strengthening accountability for improved maternal and newborn health : A mapping of studies in Sub-Saharan Africa. International Journal of Gynecology and Obstetrics, 135(3), 345–357. 

  24. McCabe, JT., Smith, NM., Leslie, PW., Telligman, AL., (2014). Livelihood Diversification through Migration among a Pastoral People: Contrasting Case Studies of Maasai in Northern Tanzania. Hum Organ, 73(4), 389–400.

  25. Mosdøl, A., Lidal, IB., Straumann, GH., Vist, GE,. (2017). Targeted mass media interventions promoting healthy behaviours to reduce risk of non-communicable diseases in adult, ethnic minorities. Cochrane Database Syst Rev, 2, CD011683.

  26. National Bureau of Statistics, NBS,. (2012). “Simanjiro District Homepage for the 2012, Tanzania National Census.” Dar es salaam, Tanzania.

  27. Pasha, O., Goldenberg, RL., Mcclure, EM., Saleem, S., Goudar, SS., Althabe, F., Patel, A., Esamai, F., Garces, A., Chomba, E., Mazariegos, M., Kodkany, B., Belizan, JM., Derman, RJ., Hibberd, PL., Carlo, WA., Liechty, EA., Hambidge, KM., Buekens, P., Wallace, D., Howard-Grabman, L., Stalls, S., Koso-Thomas, M., Jobe, AH.,  Wright, LL. (2010),. Communities , birth attendants and health facilities : a continuum of emergency maternal and newborn care ( the global network ’ s EmONC trial ). BMC Pregnancy and Childbirth, 10(1), 82. 

  28. Pfeiffer, C., & Mwaipopo, R., (2013). Delivering at home or in a health facility ? health-seeking behaviour of women and the role of traditional birth attendants in Tanzania. BMC Pregnancy and Childbirth, 13, 55.

  29. Reynolds J,. (2011). Only the Mountains Do Not Move: A Maasai Story of Culture and Conservation. Lee & Low Books.

  30. Roggeveen, Y., Schreuder, R., Zweekhorst, M., Manyama, M., Hatfield, J., Scheele, F., van Roosmalen J,. (2016). Developing a Pictorial Sisterhood Method in collaboration with illiterate Maasai traditional birth attendants in northern Tanzania. Int J Gynaecol Obstet., 135(1), 65–8.

  31. Rollinger, JM., Langer, T., Stuppner. H,. (2006). Strategies for efficient lead structure discovery from natural products. Curr Med Chem., 13(13), 1491–507.

  32. Roulette, CJ., Njau, EA., Quinlan, MB., Quinlan, RJ., Call, DR,. (2018). Medicinal foods and beverages among Maasai agro-pastoralists in northern Tanzania. J Ethnopharmacol, 216, 191–202.

  33. Saitoti, TO., Beckwith, C,. (1990). Maasai. New York, USA: Harry N. Abrams.

  34. Sialubanje, C., Massar, K., Hamer, DH, Ruiter, RA,. (2015). Reasons for home delivery and use of traditional birth attendants in rural Zambia: A qualitative study. BMC Pregnancy and Childbirth, 15(1), 1–12. 

  35. Srikanthan, A., & Reid, RL,. (2008). Religious and cultural influences on contraception. J Obstet Gynaecol Can., 30(2), 129–137.

  36. Stanifer, JW,, Patel, UD., Karia, F., Thielman, N., Maro, V., Shimbi, D., Kilaweh, H., Lazaro, M., Matemu, O., Omolo, J., Boyd, D. (2015). The Determinants of Traditional Medicine Use in Northern Tanzania: A Mixed-Methods Study. PLoS One, 10(4), e0122638.

  37. Stephens J,. (2017). In and out of the Maasai Steppe. HSRC Press.

  38. ten Hoope-Bender, P., Martin Hilber, A., Nove, A., Bandali, S., Nam, S., Armstrong, C., Ahmed, AM., Chatuluka, MG., Magoma, M., Hulton, L,. (2016). Using advocacy and data to strengthen political accountability in maternal and newborn health in Africa. International Journal of Gynecology and Obstetrics, 135(3), 358–364. 

  39. Terry PE, (2018). The Parity in Health Promotion Issue. Am J Health Promot, 32(2), 261–263.

  40. Theuring, S., Koroma, AP., & Harms, G,. (2018). “In the hospital, there will be nobody to pamper me”: A qualitative assessment on barriers to facility-based delivery in post-Ebola Sierra Leone 11 Medical and Health Sciences 1117 Public Health and Health Services. Reproductive Health, 15, 155. 

  41. Thikra Sharif, JB,. (2015). The anthropological approach challenges the conventional approach to bioethical dilemmas: a Kenyan Maasai perspective. Afr Health Sci, 15(2), 628–633.

  42. Tong, A., Sainsbury, P., & Craig, J. (2007). Consolidated criteria for reporting qualitative research (COREQ): A 32-item checklist for interviews and focus groups. International Journal for Quality in Health Care, 19(6), 349–357. 

  43. Vasan, A., Ellner, A., Lawn, S. D., Gove, S., Anatole, M., Gupta, N., Drobac P., Nicholson T., Seung, K., Mabey DC., Farmer PE,. (2014). Integrated care as a means to improve primary care delivery for adults and adolescents in the developing world: a critical analysis of Integrated Management of Adolescent and Adult Illness (IMAI). BMC Medicine, 12, 6. 

  44. WHO., UNICEF., UNFPA., The World Bank., The United Nations Population Division,. (2015). Sexual and Reproductive Health. Trends in maternal mortality: 1990 to 2015. Estimates by WHO, UNICEF, UNFPA, World Bank Group and the United Nations Population Division. Geneva Switzerland.

  45. World Health Organization,. (2008). Proportion of births attended by a skilled attendant: 2008 updates. Geneva.

About Us

The Asian Institute of Research is an online and open-access platform to publish recent research and articles of scholars worldwide. Founded in 2018 and based in Indonesia, the Institute serves as a platform for academics, educators, scholars, and students from Asia and around the world, to connect with one another. The Institute disseminates research that is proven or predicted to be of significant influence for the general public.

Stay Connected

  • Instagram - Black Circle
  • Facebook - Black Circle
  • LinkedIn - Black Circle

Contact Us

Please send all inquiries to the email:

editorial@asianinstituteofresearch.org

Business Address:

5th Floor, Kavling 507, Fajar Graha Pena Tower, Jl. Urip Sumohardjo No.20, Makassar, Indonesia 90234

Copyright © 2018 The Asian Institute of Research. All rights reserved