The maternal and perinatal health data system in the Kilimanjaro Region, Tanzania: a landscape review including a qualitative study

Background The World Health Organization (WHO) advocates the use of digital health interventions to strengthen health systems globally. This landscape review evaluated how data related to maternal and neonatal health is recorded and utilized for clinical and policy decision-making in the Kilimanjaro Region of Tanzania. Method This landscape review employed a dual method approach, initially quantifying data recording practices of each clinic and then using qualitative interviews to explore how data is currently captured and utilized. We conducted interviewed with seven Nurse-Midwives, eight Lead Obstetricians at district hospitals, seven District Medical Officers, and seven District Reproductive and Child Health Coordinators. Qualitative data analysis was performed using NVivo software. Results In the region's seven districts, there are 489 healthcare facilities offering Reproductive and Child Health Services, delivery, infant and child care. The facilities comprise 22 hospitals, 62 health centers, 353 dispensaries, and 52 clinics. In 2021, there were 45,343 births with a maternal mortality rate of 146 per 100,000 live births, a neonatal mortality rate of 10.1 per 1,000 live births, and a stillbirth rate of 4 per 1,000 births. Additionally, 20.3% of births were delivered via C-section. Although there was a notable decline in maternal and neonatal mortality rates (from 112 to 51 vs 9.5 to 3.7 deaths per 100,000 live births) from 2020 to 2023, the 2021 data revealed unexpectedly high maternal mortality rates. The qualitative study highlighted issues with the data recording system, which is complex and time-consuming, involving multiple paper-based and digital records. Challenges include data volume, loss, and retrieval issues, affecting clinical decision-making. This data is crucial for identifying resource needs, monitoring health trends like low antenatal care uptake, and advocating for changes in resources, guidelines, and policies at regional and national levels. Conclusion Quantitative data indicates a significant rise in maternal and neonatal mortality rates in the Kilimanjaro region during 2020-2021, followed by a decrease in 2022-2023. Additionally, early antenatal care (ANC) uptake remains below 50%. The qualitative study suggests that paper records are time-consuming and prone to incomplete data making it difficult to use due to their storage approach and the risk of damage to the physical books.