Andrea Pembe
Biographic Data
| ID | 1741796 |
|---|---|
| NAME | Andrea Pembe |
| GIVEN NAMES | Andrea |
| FAMILY NAME | Pembe |
| SIGNATURE | PEMBE A |
| AFFILIATIONS | Muhimbili University of Health and Allied Sciences |
| ORCID | 0000-0002-8090-3298 |
| VERIFIED | Yes |
| TOTAL WORKS | 39 |
| TOTAL CITATIONS | 6 |
| AUTHOR COUNT | 39 |
| EDITOR COUNT | 0 |
| FIRST PUBLICATION YEAR | 2013 |
| LATEST PUBLICATION YEAR | 2026 |
| H-INDEX | 1 |
‘ I am now confident in the counseling and in inserting the loop’
BACKGROUND: Unmet need for contraception among women is high in Tanzania. Hormonal intrauterine device was not among the contraceptives offered in public health facilities in Tanzania until a Ministry of Health pilot in 2023-2024. OBJECTIVE: Explore the feasibility of providing hormonal intrauterine devices in public health facilities in Tanzania. METHODS: An observational exploratory mixed-methods study design was conducted, using cross-sectiona…
(De)coding perinatal deaths
BACKGROUND: To reduce perinatal deaths, identification of their causes is paramount. 'The WHO application of ICD-10 to deaths during the perinatal period' (ICD-PM) was developed to improve the quality of perinatal death data. OBJECTIVES: To determine stillbirth and very early neonatal death rates across 16 hospitals in Benin, Malawi, Tanzania, and Uganda, examine causes of death and associated maternal conditions applying the ICD-PM, and assess h…
Indicator menus
There is strong impetus for internationally standardized measurement for maternal and neonatal health (MNH) to facilitate global benchmarking and accountability. Recent funding cuts have sharpened debates about whose priorities should guide measurement and what role international-level actors should play. This qualitative study combined observations and 24 semi-structured interviews in 2023-2025 with experts across multilateral agencies, bilatera…
“ I just love it - I know there is something which has not given me worry when I am with my partner ”
BACKGROUND: Hormonal intrauterine device (IUD) is an effective contraceptive method with high user satisfaction rates. To guide the introduction of hormonal IUD into the public sector in Tanzania, an operational research study was conducted to assess client acceptability of hormonal IUDs. OBJECTIVE: To explore clients' perspectives on contraceptives and experiences with hormonal IUDs. METHODS: = 15 at endline) with hormonal IUD clients. Register …
“ Every Time You Have Sex, You Must Use an Enhancing Substance.” Erectile Dysfunction and Its Treatment Among Young and Adult Males in Dar es Salaam, Tanzania
Background Erectile dysfunction (ED) is one of the underexplored conditions commonly affecting older adults. Recently, it has been reported even among younger men and linked to the use of sex-enhancing substances (SESs). The determinants of ED and the impacts of using SESs are poorly understood. We determined the proportion of ED, its associated sociodemographic factors, and explored the awareness of ED and the types of SES used among young and a…
“Implementing a policy is something else”. Governance of a complex health management information system and its digitalization in Tanzania
Health management information systems are crucial for a country’s health service planning and monitoring. Research findings indicate however that data produced within this system is often of low quality or not used for decision-making in low-resource settings like Tanzania. Policymaking and -implementation towards efficient data processes and use take place in an environment challenged by limited availability of human and other resources, low lev…
Partial pictures
Measurement of contact coverage of maternal and newborn health services may overestimate the benefits of the care that is provided, because the quality of care is not captured. It is therefore important to better understand the opportunities and challenges of capturing elements of care quality in routine health information systems (RHIS). This study explored healthcare workers’ (HCWs), health sector managers’ and policymakers’ perspectives on the…
Hypertensive disorders of pregnancy and perinatal outcomes
INTRODUCTION: Hypertensive disorders of pregnancy (HDP) have been linked with increased risk for maternal and offspring complications in high-income settings. However, in resource-limited settings, studies with robust measurement of HDP, including severity and timing, and perinatal outcomes are limited. METHODS: We analysed data from two prospective cohorts of nulliparous women in India (n=10 570 pregnancies) and Tanzania (n=10 299 pregnancies) w…
Low-dose calcium supplementation during pregnancy in low and middle-income countries
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 similarly efficacious as high-dose supplementation. We assessed the cost-effectiveness of low-dose calcium supplementatio…
“We have theoretical knowledge, but these are not things we do regularly”
Screening for gestational diabetes mellitus (GDM) during antenatal care (ANC) is crucial for maternal and fetal health. It offers an opportunity for prevention, timely diagnosis, and treatment of cardiometabolic complications during pregnancy and over women’s and babies’ life course. We aimed to describe GDM screening service provision during ANC in two hospitals in Tanzania, focusing on gaps and opportunities for improving GDM screening services…
Hyperglycemia in pregnancy
Screening for hyperglycaemia in pregnancy (HIP) is an entry point to a healthy pregnancy and childbirth for both the woman and child, and offers a window of opportunity for the prevention of cardio-metabolic complications over the life-course of the woman and newborn. In Tanzania, two different screening algorithms to identify women with HIP are recommended, with no clear understanding of which performs better. We aimed to determine the prevalenc…
Antenatal corticosteroids for pregnant women at risk of preterm labour in low- and middle-income countries
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 must demonstrate readiness to ensure safe and effective ACS use. We aimed to assess ACS utilisatio…
Mixed vulnerabilities
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 childbirth. We assessed whether emergency referral during childbirth was associated with adverse event…
Getting the numbers right
What makes routine maternal and neonatal health data to be 'good quality'? That depends on whom you ask - the people collecting and reporting these data across health system levels have different priorities and face varying constraints. Data are constructed by people, about people, and they both reflect and impact human interactions. This study analyses the power dynamics shaping how routine health data are collected and reported in labour wards …
Inequalities in use of hospitals for childbirth among rural women in sub-Saharan Africa
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 comparatively assessing hospital use in rural SSA by wealth and parity. METHODS: Countries in SSA with…
Data for whom? Experiences and perceptions of a perinatal eRegistry in two hospitals in Mtwara region, Tanzania
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 descriptive account of stakeholders' experiences and provide insight into key structural drivers and …
Experiences, acceptability and barriers to calcium supplementation during pregnancy in Dar es Salaam, Tanzania
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 a mixed methods evaluation study to assess experiences, acceptability and barriers to high-dose cal…
Midwife-Led Mobile Antenatal Clinic
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 Kitaani" and equipped with necessary tools and staff, served seven villages in the Kisarawe district …
Neonatal and perinatal mortality in the urban continuum
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 association between urban residence and neonatal/perinatal mortality in Tanzania. METHODS: The Tanzania Demog…
Understanding maternity care providers’ use of data in Southern Tanzania
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 care providers' perceptions of data and how they use it, with a view to co-design interventions to imp…
Community-based transport system in Shinyanga, Tanzania
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 to determine the cost-effectiveness of this intervention in comparison to the standard ambulance sys…
Facilitators and barriers of implementation of routine postnatal care guidelines for women
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 review guided by the standard principles of Arksey & O'Malley's framework. We used the critical interp…
A mixed-methods study of maternal health care utilisation in six referral hospitals in four sub-Saharan African countries before and during the Covid-19 pandemic
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 during the first year of the pandemic. METHODS: Mixed-methods design combining three data sources: (…
A growing disadvantage of being born in an urban area? Analysing urban–rural disparities in neonatal mortality in 21 African countries with a focus on Tanzania
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 is to understand this disparity in SSA countries and examine the specific factors potentially unde…
A tale of 22 cities
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 care (CoC) in 22 large African cities. METHODS: 1 million inhabitants in 2015. Women with live birt…
Beyond the law
Misoprostol has during the past few years become an important obstetric drug used for different purposes both within and outside hospitals in Tanzania. In this paper, we analyze how misoprostol is perceived, accessed and used off-label as an abortion drug in the city and region of Dar es Salaam. The study took place in Dar es Salaam's three districts from July to November 2015, and had a qualitative explorative approach. We carried out in-depth i…
Getting the numbers right
What makes routine maternal and neonatal health data to be 'good quality'? That depends on whom you ask - the people collecting and reporting these data across health system levels have different priorities and face varying constraints. Data are constructed by people, about people, and they both reflect and impact human interactions. This study analyses the power dynamics shaping how routine health data are collected and reported in labour wards …
Prolonged sexual abstinence after childbirth
BACKGROUND: Prolonged sexual abstinence after childbirth is a socio-cultural practice with health implications, and is described in several African countries, including Tanzania. This study explored discourses on prolonged postpartum sexual abstinence in relation to family health after childbirth in low-income suburbs of Dar es Salaam, Tanzania. METHODS: Data for the discourse analysis were collected through focus group discussions with first-tim…
Birth preparedness and complication readiness – a qualitative study among community members in rural Tanzania
BACKGROUND: Birth preparedness and complication readiness (BP/CR) strategies are aimed at reducing delays in seeking, reaching, and receiving care. Counselling on birth preparedness is provided during antenatal care visits. However, it is not clear why birth preparedness messages do not translate to utilisation of facility delivery. This study explores the perceptions, experiences, and challenges the community faces on BP/CR. DESIGN: A qualitativ…
Community health workers can improve male involvement in maternal health
BACKGROUND: Male involvement in maternal health is recommended as one of the interventions to improve maternal and newborn health. There have been challenges in realising this action, partly due to the position of men in society and partly due to health system challenges in accommodating men. The aim of this study was therefore to evaluate the effect of Home Based Life Saving Skills training by community health workers on improving male involveme…
Why do women not adhere to advice on maternal referral in rural Tanzania? Narratives of women and their family members
BACKGROUND: In most low-income countries, many women with high-risk pregnancies and complications do not reach the referral hospitals despite the provision of referral advice. OBJECTIVE: To explore how antenatal maternal referral advice is understood and handled in a rural Tanzanian community. METHODS: Individual in-depth interviews were conducted with six women who did not go to hospital and 13 people who were involved in the referral advice. Na…
“Every Newborn-BIRTH” protocol
BACKGROUND: - Birth Indicators Research Tracking in Hospitals (EN-BIRTH) study aims to validate selected newborn and maternal indicators for routine tracking of coverage and quality of facility-based care for use at district, national and global levels. METHODS: EN-BIRTH is an observational study including >20 000 facility births in three countries (Tanzania, Bangladesh and Nepal) to validate selected indicators. Direct clinical observation will …
Voices from the frontline
INTRODUCTION: The COVID-19 pandemic has substantially impacted maternity care provision worldwide. Studies based on modelling estimated large indirect effects of the pandemic on services and health outcomes. The objective of this study was to prospectively document experiences of frontline maternal and newborn healthcare providers. METHODS: We conducted a global, cross-sectional study of maternal and newborn health professionals via an online sur…
Health system redesign for equity in maternal and newborn health must be codesigned, country led, adapted to context and fit for purpose
No Abstract available. Comment
“We do what we can do to save a woman” health workers’ perceptions of health facility readiness for management of postpartum haemorrhage
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 some positive albeit limited effect on clinical management and reduction of postpartum haemorrhage (…
Beyond the law
Misoprostol has during the past few years become an important obstetric drug used for different purposes both within and outside hospitals in Tanzania. In this paper, we analyze how misoprostol is perceived, accessed and used off-label as an abortion drug in the city and region of Dar es Salaam. The study took place in Dar es Salaam's three districts from July to November 2015, and had a qualitative explorative approach. We carried out in-depth i…
Mismatched ambition, execution and outcomes
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 and managers in implementing the MDSR system. METHODS: An exploratory qualitative study was carried…
Inequity in uptake of hospital-based childbirth care in rural Tanzania
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) mostly only routine childbirth care is available. With over half (54%) of rural births in facilities,…
A mixed-methods study of maternal health care utilisation in six referral hospitals in four sub-Saharan African countries before and during the Covid-19 pandemic
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 during the first year of the pandemic. METHODS: Mixed-methods design combining three data sources: (…
A growing disadvantage of being born in an urban area? Analysing urban–rural disparities in neonatal mortality in 21 African countries with a focus on Tanzania
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 is to understand this disparity in SSA countries and examine the specific factors potentially unde…
A tale of 22 cities
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 care (CoC) in 22 large African cities. METHODS: 1 million inhabitants in 2015. Women with live birt…
‘We are not going to shut down, because we cannot postpone pregnancy’
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-methods design using three data sources: (1) qualitative data from repeated rounds of semi-structured int…
No increase in use of hospitals for childbirth in Tanzania over 25 years
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%. Facilities however are not all the same, with advanced management of childbirth complications gene…
Low Use of Long-Acting Reversible Contraceptives in Tanzania
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 use was determined through various analyses. Among women with a partner/husband, 7.27% used LARCs, 2…
Neonatal and perinatal mortality in the urban continuum
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 association between urban residence and neonatal/perinatal mortality in Tanzania. METHODS: The Tanzania Demog…
Understanding maternity care providers’ use of data in Southern Tanzania
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 care providers' perceptions of data and how they use it, with a view to co-design interventions to imp…
Community-based transport system in Shinyanga, Tanzania
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 to determine the cost-effectiveness of this intervention in comparison to the standard ambulance sys…
Facilitators and barriers of implementation of routine postnatal care guidelines for women
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 review guided by the standard principles of Arksey & O'Malley's framework. We used the critical interp…
Inequalities in use of hospitals for childbirth among rural women in sub-Saharan Africa
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 comparatively assessing hospital use in rural SSA by wealth and parity. METHODS: Countries in SSA with…
Data for whom? Experiences and perceptions of a perinatal eRegistry in two hospitals in Mtwara region, Tanzania
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 descriptive account of stakeholders' experiences and provide insight into key structural drivers and …
Experiences, acceptability and barriers to calcium supplementation during pregnancy in Dar es Salaam, Tanzania
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 a mixed methods evaluation study to assess experiences, acceptability and barriers to high-dose cal…
Midwife-Led Mobile Antenatal Clinic
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 Kitaani" and equipped with necessary tools and staff, served seven villages in the Kisarawe district …
Global Maternal and Child Health (32 works) · Medicine (30 works) · Tanzania (26 works) · Environmental health (20 works) · Health care (17 works) · Pregnancy (16 works) · Nursing (15 works) · Economic growth (13 works) · Population (12 works) · Qualitative research (11 works)