Andrea Barnabas Pembe

• MD, MMed (Obs/gyn), PhD
• Professor at Muhimbili University of Health and Allied Sciences

Background Antenatal multiple micronutrient supplementation (MMS) has been shown to be more effective than iron-folic acid (IFA) alone in reducing adverse pregnancy and birth outcomes. However, there is a concern that MMS containing 30 mg of iron may be less effective in reducing maternal anemia compared to IFA supplements containing 60 mg of iron....

Background Administering antenatal corticosteroids (ACS) to pregnant women at risk of imminent preterm labour improves newborn survival. However, ACS remains substantially underused in low- and middle-income countries (LMICs), where most preterm births occur globally. Providing ACS in inadequately equipped settings can be harmful. Health facilities...

Introduction Evidence suggests that women value and benefit from having a labour companion during childbirth. However, the applicability of the evidence to low-income and lower-middle-income countries is limited and varies. Thus, we assessed the association between the presence of labour companions and mistreatment in 16 hospitals of Benin, Malawi,...

Background The suspension and/or termination of many programmes funded through the United States Agency for International Development (USAID) by the new US administration has severe short- and long-term negative impacts on the health of people worldwide. We draw attention to the termination of the Demographic and Health Surveys (DHS) Program, which...

Background: The suspension and/or termination of many programmes funded through the United States Agency for International Development (USAID) by the new US administration has severe short-and long-term negative impacts on the health of people worldwide. We draw attention to the termination of the Demographic and Health Surveys (DHS) Program, which...

The suspension and threatened closure of USAID has severe short-and long-term negative impacts on the health of people worldwide. 1,2 We draw attention to a consequence of the new US administration's actions on our ability to understand the levels and changes in population health outcomes and behaviours. This is through co-financing and provision o...

The suspension and threatened closure of USAID has severe short- and long-term negative impacts on the health of people worldwide. We draw attention to a consequence of the new US administration's actions on our ability to understand the levels and changes in population health outcomes and behaviours. This is through co-financing and provision of t...

Background Small vulnerable newborn types, defined by combinations of being born too soon or too small, have distinct determinants and health consequences. We aimed to assess the effects of prenatal multiple micronutrient supplementation (MMS) and small-quantity lipid-based nutrient supplementation (SQ-LNS) on small vulnerable newborn types, which...

Identification of interacting vulnerabilities is essential to reduce maternal and perinatal mortality in sub-Saharan Africa (SSA). High parity (≥ 5 previous births) is an underemphasized biological vulnerability linked to poverty and affecting a sizeable proportion of SSA births. Despite increased risk, high parity women rarely use hospitals for ch...

Background Tanzania, like most low- and middle-income countries, is facing an increasing prevalence of obesity in the general population, including among women of reproductive age. Excess weight pre-pregnancy is a risk factor for the onset of gestational diabetes mellitus (GDM), which is associated with several poor pregnancy outcomes. Screening fo...

Introduction Digital data systems have the potential to improve data quality and provide individual-level information to understand gaps in the quality of care. This study explored experiences and perceptions of a perinatal eRegistry in two hospitals in Mtwara region, Tanzania. Drawing from realist evaluation and systems thinking, we go beyond a de...

Objective We first estimated the prevalence of primary and secondary infertility in Tanzania and then examined its association with recent experiences of intimate partner violence (IPV). Methods We used cross‐sectional data from the Tanzania Demographic and Health Survey 2022 and included 6894 women aged 20–49 years to estimate the prevalence of p...

Background : Calcium supplementation during pregnancy can reduce the risk of preeclampsia and preterm birth. Few countries have implemented WHO-recommended high-dose calcium supplementation (1500-2000mg/day), due to adherence and cost concerns. However, low-dose calcium supplementation (one 500mg tablet daily) has recently been shown to be similarl...

Participating in antenatal clinics is a major determinant in reducing poor maternal and neonatal birth outcomes. We aimed to evaluate the utilization of antenatal clinic (ANC) services provided by a mobile clinic led by skilled midwives and determine the acceptability in the Pwani region, Tanzania. For a year, the mobile clinic, nicknamed “Mkunga K...

Calcium supplementation in pregnancy is recommended in contexts with low dietary calcium intake to reduce the risk of pre‐eclampsia and its complications. The World Health Organisation suggested high‐dose calcium supplementation (1500–2000 mg/day), divided into three doses and taken at different times from daily iron‐folic supplements. We conducted...

Introduction There are significant disparities in access to safe and affordable surgery, particularly in LMICs. National Surgical Obstetric and Anesthesia Plans (NSOAPs) emerged as crucial national policy frameworks to address this gap. Although some Sub-Saharan African countries have developed and launched NSOAPs, there is limited information on e...

Growing evidence suggests that extreme heat events affect both pregnant women and their infants, but few studies are available from sub-Saharan Africa. Using data from 138,015 singleton births in 16 hospitals in Benin, Malawi, Tanzania and Uganda, we investigated the association between extreme heat and early perinatal deaths, including antepartum...

Introduction: Health management information systems are crucial for a country′s health service planning and monitoring. Research indicates that generated data is often of low quality or not used for decision-making in low-resource settings. Digitalization potentially alleviates these problems, but scale-up in these countries is hampered by unreliab...

Background Tanzania has made significant progress in improving access to HIV care and treatment. However, virologic suppression among people living with HIV (PLHIV) has not been fully realized. In March 2019, Tanzania introduced a World Health Organization (WHO)—recommended dolutegravir-based regimen as the default first-line regimen. Eighteen mont...

Background Antenatal corticosteroids (ACS) use among pregnant women with a high likelihood of preterm labor improves newborn survival. ACS adoption in low- and middle-income countries (LMICs) remains limited. Giving ACS in inadequately equipped settings could be harmful to mothers and newborns. Thus, health facilities have to demontrate readiness t...

(Abstracted from N Engl J Med 2024;390:143–53) Many maternal deaths globally are associated with hypertensive disorders of pregnancy, which include preeclampsia. Several interventions have been investigated as possible preventive measures, one of which is calcium supplementation.

Background The majority of women experience pain during childbirth. Offering and supporting women to use different methods for coping with pain is an essential competency for maternity care providers globally. Research suggests a gap between what women desire for pain management and what is available and provided in many low-and middle-income setti...

Objective To assess stillbirth mortality by Robson ten‐group classification and the usefulness of this approach for understanding trends. Design Cross‐sectional study. Setting Prospectively collected perinatal e‐registry data from 16 hospitals in Benin, Malawi, Tanzania and Uganda. Population All women aged 13–49 years who gave birth to a live o...

Background: Approximately 15 million children are born each year prematurely, representing more than 10 percent of all child-births worldwide. Prematurity is an acute event and the leading cause of death among newborns and children under five. Sixty percent of these premature deaths occur in Sub-Saharan Africa and Southeast Asia. Objective: The cur...

Background Intrapartum continuity of care to reduce maternal morbidity and mortality relies heavily on a functional and effective referral system between tiers of care. Capacity building of providers in managing intrapartum referrals is expected to improve the efficiency of the referral system, but this does not always work in practice. This study...

Introduction Rising facility births in sub-Saharan Africa (SSA) mask inequalities in higher-level emergency care—typically in hospitals. Limited research has addressed hospital use in women at risk of or with complications, such as high parity, linked to poverty and rurality, for whom hospital care is essential. We aimed to address this gap, by com...

BACKGROUND The World Health Organization recommends 1500 to 2000 mg of calcium daily as supplementation, divided into three doses, for pregnant persons in populations with low dietary calcium intake in order to reduce the risk of preeclampsia. The complexity of the dosing scheme, however, has led to implementation barriers. METHODS We conducted tw...

Extreme heat events affect both pregnant women and their infants. We applied a time-stratified case-crossover design including 124,819 singleton births in a prospective observational study in 16 hospitals in Benin, Malawi, Tanzania, and Uganda to investigate the association between extreme heat and timing of perinatal death. We observed weak associ...

Background Postnatal care (PNC) has the potential to prevent a substantial burden of maternal and newborn morbidity and mortality. This scoping review aimed to identify and synthesise themes related to facilitators and barriers of implementation of guidelines on routine PNC for women (postpartum care) in all settings. Methods This is a scoping rev...

Objective : To better understand underlying factors of peripartum mortality we assessed variations in mortality by Robson 10-group classification. Design: Cross-sectional study. Setting: Prospectively collected perinatal e-registry data from 16 hospitals in Benin, Malawi, Tanzania and Uganda. Population: All women aged 13-49 who gave birth to a liv...

Background For successful HIV response, updated information on the burden and progress toward HIV elimination targets are required to guide programmatic interventions. We used data from the 2020 HIV sentinel surveillance to update on the burden and factors associated with HIV infection, HIV status awareness, and ART coverage among pregnant women in...

Background Routine health facility data provides the opportunity to monitor progress in quality and uptake of health care continuously. Our study aimed to assess the reliability and usefulness of emergency obstetric care data including temporal and regional variations over the past five years in Tanzania Mainland. Methods Data were compiled from t...

Background The prevalence of people who are overweight or obese is increasing globally, especially in low- and middle-income countries. High body mass index (BMI) among women of reproductive age is a risk factor for various adverse reproductive and pregnancy outcomes. This study aims to describe trends over time in the distribution of BMI among Tan...

Objectives The COVID-19 pandemic affected provision and use of maternal health services. This study describes changes in obstetric complications, referrals, stillbirths and maternal deaths during the first year of the pandemic and elucidates pathways to these changes. Design Prospective observational mixed-methods study, combining monthly routine...

Background Syphilis has detrimental effects on the health of the mother and that of both fetuses and newborns exposed in utero or at delivery. Understanding its local epidemiology is essential for policies, planning, and implementation of targeted preventive interventions. Using data from the 2020 National Sentinel Surveillance of pregnant women at...

In achieving the sustainable development goal 3.1, Tanzania needs substantial investment to address the three delays which responsible for most of maternal deaths. To this end, the government of Tanzania piloted a community-based emergency transport intervention to address the second delay through m-mama program. This study examined secondary data...

[This corrects the article DOI: 10.1371/journal.pgph.0000345.].

Background: For successful HIV response, updated information on the burden and progress towards elimination targets are required to guide programmatic interventions. We used data from the 2020 HIV sentinel surveillance to update on the burden, HIV status awareness, ART coverage, and factors associated with HIV infection among pregnant women in Tanz...

Background Syphilis has detrimental effects on the health of the mother and that of the child when pregnant. Understanding its local epidemiology is essential for policies, planning, and implementation of targeted preventive interventions. Using data from the 2020 National Sentinel Surveillance of pregnant women attending antenatal clinics (ANCs) i...

Introduction Recent studies suggest that the urban advantage of lower neonatal mortality in urban compared with rural areas may be reversing, but methodological challenges include misclassification of neonatal deaths and stillbirths, and oversimplification of the variation in urban environments. We address these challenges and assess the associatio...

Background: Tanzania Maternal Death Surveillance and Response (MDSR) system introduced in 2015 emphasizes review of facility maternal deaths with little community involvement. Involving the community in deaths enquiry can help to make better strategies to prevent future deaths. We aimed to explore family members (caregivers) perceptions and experi...

Introduction: The Caesarean Section (CS) rate is dramatically increasing across obstetric populations. This study aimed to determine the adherence to criteria for standard diagnosis of the common indications for CS among women of a low-risk group. This group, known as group 3 in the Robson classification, is multiparous, term with singleton pregnan...

Background The emergence of HIV drug resistance mutations (DRMs) is of significant threat to achieving viral suppression (VS) in the quest to achieve global elimination targets. We hereby report virologic outcomes and patterns of acquired DRMs and its associated factors among adolescents and young adults (AYA) from a broader HIV drug resistance sur...

Background: Gestational weight gain (GWG) is a modifiable factor associated with maternal and child health outcomes, but the relationship between diet quality and GWG has not been evaluated using metrics validated for low-income and middle-income countries (LMICs). Objective: This study aimed to investigate relationships between diet quality, so...

Background Despite the scale-up of ART and the rollout in Tanzania of dolutegravir, an integrase strand transfer inhibitor (INSTI), treatment success has not been fully realized. HIV drug resistance (HIVDR), including dolutegravir resistance, could be implicated in the notable suboptimal viral load (VL) suppression among HIV patients. Objectives T...

Introduction Health information management system data is collected for national planning and evaluation but is rarely used for healthcare improvements at subnational or facility-level in low-and-middle-income countries. Research suggests that perceived data quality and lack of feedback are contributing factors. We aimed to understand maternity car...

Introduction In achieving sustainable development goal 3.1, Tanzania needs substantial investment to address the persistent burden of maternal mortality. Efforts are needed to curtail the three delays which underlie most of the deaths. The government of Tanzania implemented a community-based emergency transport intervention to address the second de...

Background Fear of childbirth is common both before and after childbirth, often leading to complications in mother and new-born. The Wijma Delivery Expectancy/Experience Questionnaires (W-DEQ) are commonly used to measure fear of childbirth among women before (version A) and after childbirth (version B). The tools are not yet validated in the Tanza...

Introduction Neonatal mortality might be higher in urban areas. This paper aims to minimize challenges related to misclassification of neonatal deaths and stillbirths, and oversimplification of the variation in urban environments to accurately estimate the direction and strength of the association between urban residence and neonatal/perinatal mort...

Background Fear of childbirth (FoB) and depressive symptoms (DS) are experienced by many women and can negatively affect women during and after pregnancy. This study assessed patterns of FoB and DS over time and associations of postpartum FoB and DS with sociodemographic and obstetric characteristics. Methods We conducted a longitudinal study at s...

Introduction Health information management system data is collected for national planning and evaluation but rarely used for health care improvements at the sub-national or facility-level in low-and-middle-income countries. Research suggests that perceived data quality and lack of feedback are contributing factors. We aimed to understand maternity...

Background In-service training, including the competency-based Helping Mothers Survive Bleeding After Birth (HMS BAB) is widely implemented to improve the quality of maternal health services. To better understand how this specific training responds to the needs of providers and fits into the existing health systems, we explored health workers’ expe...

Background Gestational weight gain (GWG) below or above the Institute of Medicine (IOM) recommendations has been associated with adverse perinatal outcomes. Few studies have examined the effect of prenatal nutrient supplementations on GWG in low- and middle-income countries (LMICs). Objectives To investigate the effects of multiple micronutrient s...

Improving childbirth care in rural settings in sub-Saharan Africa is essential to attain the commitment expressed in the Sustainable Development Goals to leave no one behind. In Tanzania, the period between 1991 and 2016 was characterized by health system expansion prioritizing primary health care and a rise in rural facility births from 45% to 54%...

Background Appropriate gestational weight gain (GWG) is important for optimal pregnancy outcomes. This study prospectively evaluated the associations between GWG during the second and third trimesters of pregnancy and adverse pregnancy outcomes in an urban Tanzanian pregnancy cohort. Methods We used data from a randomized clinical trial conducted...

Introduction: Gestational weight gain (GWG) is associated with fetal and newborn health; however, data from sub-Saharan Africa are limited. Methods: We used data from a prenatal micronutrient supplementation trial among a cohort of HIV-negative pregnant women in Dar es Salaam, Tanzania to estimate the relationships between GWG and newborn outcom...

We aimed to determine the prevalence and factors associated with the use of long-acting reversible contraceptives (LARCs) among women of reproductive age in Tanzania. We analyzed the Tanzania Demographic and Health Survey (DHS) data from 2015 to 2016. The study included 8189 women aged 15–49 years. The relationship between various factors and LARC...

Introduction Globally, the majority of births happen in urban areas. Ensuring that women and their newborns benefit from a complete package of high-quality care during pregnancy, childbirth and the postnatal period present specific challenges in large cities. We examine health service utilisation and content of care along the maternal continuum of...

Introduction Referral hospitals in sub-Saharan Africa are located in crowded urban areas, which were often epicentres of the COVID-19 pandemic. This paper prospectively assesses how maternal healthcare was provided in six referral hospitals in Guinea, Nigeria, Tanzania and Uganda during the first year of the COVID-19 pandemic. Methods Mixed-method...

Introduction In sub-Saharan Africa, referral hospitals are important sources of key maternal health services, especially during a crisis such as the COVID-19 pandemic. This study prospectively assessed the effect of the COVID-19 pandemic on maternal health service utilisation in six large referral hospitals in Guinea, Nigeria, Tanzania and Uganda d...

Background Increasing the number of specialized human resources for health is paramount to attainment of the United Nations sustainable development goals. Higher learning institutions in low-and middle-income countries must address this necessity. Here, we describe the 5-years trends in accreditation of the clinical and non-clinical postgraduate (P...

Introduction Neonatal mortality rate (NMR) has been declining in sub-Saharan African (SSA) countries, where historically rural areas had higher NMR compared with urban. The 2015–2016 Demographic and Health Survey (DHS) in Tanzania showed an exacerbation of an existing pattern with significantly higher NMR in urban areas. The objective of this study...

Background Gestational weight gain (GWG) is a modifiable risk factor associated with adverse birth outcomes. Studies have shown that the provision of multiple micronutrient supplements to pregnant women reduces the risk of low birthweight. However, the effect of multiple micronutrient supplements on GWG has been understudied. Objectives We examine...

Background Insufficient reductions in maternal and neonatal deaths and stillbirths in the past decade are a deterrence to achieving the Sustainable Development Goal 3. The majority of deaths occur during the intrapartum and immediate postnatal period. Overcoming the knowledge-do-gap to ensure implementation of known evidence-based interventions dur...

Background Hypertensive disorders of pregnancy are important causes of maternal morbidity and mortality, as well as preterm birth, the leading cause of death for children under 5 years globally. The World Health Organization currently recommends that pregnant women receive high-dose calcium supplementation (1500–2000 mg elemental calcium) for preve...

Objectives This study aimed to explore experiences of communication as an element of quality of care, among women surviving a maternal near-miss event, thus women who nearly died but survived haemorrhage, or pre-eclampsia complication during pregnancy, childbirth or within 42 days of termination of pregnancy. Design A descriptive, phenomenological...

Background Many women experience fear of childbirth (FoB) and depressive symptoms (DS) during pregnancy, but little is known about FoB among Tanzanian women. The current study aimed to assess the prevalence of FoB and DS among pregnant women and determine predictors of each and both, focusing on sociodemographic and obstetric predictors. Methods A...

Introduction: in Tanzania, for the past decade, there has been a rising trend of women with short inter-pregnancy interval (IPI) (16% to 19%). Short IPI is associated with poor maternal and neonatal outcomes. We aimed to determine the factors associated with short IPI among women attending antenatal clinic (ANC) at Mnazi Mmoja Hospital, Dar es Sal...

Introduction Gestational weight gain (GWG) is associated with fetal and newborn health; however, data from sub-Saharan Africa are limited. Methods We used data from a prenatal micronutrient supplementation trial among a cohort of HIV-negative pregnant women in Dar es Salaam, Tanzania to estimate the relationships between GWG and newborn outcomes....

Proportions of facility births are increasing throughout sub-Saharan Africa, but obstetric services vary within the health system. In Tanzania, advanced management of childbirth complications (comprehensive emergency obstetric care) is offered in hospitals, while in frontline, primary health care (PHC) facilities (health centres and dispensaries) m...

PURPOSE Cervical cancer screening is one of the strategies to prevent the disease among women at risk. Human papillomavirus (HPV) DNA testing is increasingly used as the cervical cancer screening method because of its high sensitivity. Self-collection of cervical specimens has the potential to improve participation. However, there is only limited i...

Background Appropriate gestational weight gain (GWG) is important for optimal pregnancy outcomes. This study prospectively evaluated the associations between GWG during the second and third trimesters of pregnancy and adverse pregnancy outcomes in an urban Tanzanian pregnancy cohort. Methods We used data from a randomized clinical trial conducted a...

Background Since 2015, Tanzania has been implementing the Maternal Death Surveillance and Response (MDSR) system. The system employs interactions of health providers and managers to identify, notify and review maternal deaths and recommend strategies for preventing further deaths. We aimed to analyse perceptions and experiences of health providers...

Background Postpartum haemorrhage (PPH) is a leading cause of preventable maternal mortality worldwide. The World Health Organization (WHO) recommends uterotonic administration for every woman after birth to prevent PPH. There are no standardised data collected in large-scale measurement platforms. The Every Newborn Birth Indicators Research Tracki...

Background Tanzania Maternal Death Surveillance and Response (MDSR) system introduced in 2015 emphasizes review of facility maternal deaths with little community involvement. Involving the community in deaths enquiry can help to make better strategies to prevent future deaths. We aimed to explore family members (caregivers) perceptions and experien...

Introduction: visual inspection of the cervix with acetic acid is used to control the burden of cervical cancer in low and middle-income countries. This method has some limitations and HPV DNA testing may be an alternative, but it is expensive and requires a laboratory setup. A cheaper and faster HPV tests have been developed. This study describe...

Background Maternal deaths reviews are proposed as one strategy to address high maternal mortality in low and middle-income countries, including Tanzania. Review of maternal deaths relies on comprehensive documentation of medical records that can reveal the sequence of events leading to death. The World Health Organization’s and the Tanzanian Mater...

Objectives This study aimed to explore experiences of communication as an element of quality of care, among women surviving a maternal near-miss event, thus women who nearly died but survived haemorrhage, or pre-eclampsia complication during pregnancy, childbirth or within 42 days of termination of pregnancy. Design A descriptive, phenomenological,...

Background: In many low-resource settings, in-service training is a common strategy to improve the performance of health workers and ultimately reduce the persistent burden of maternal mortality and morbidities. An evaluation of the Helping Mothers Survive Bleeding After Birth (HMS BAB) training as a single-component intervention in Tanzania found...

Background: Many women experience fear of childbirth (FoB) and depressive symptoms (DS) during pregnancy, but little is known about FoB among Tanzanian women. The current study aimed to assess the prevalence of FoB and DS among pregnant women and determine predictors of each and both, focusing on sociodemographic and obstetric predictors. Methods:...