Factors Related to the Practice of Vacuum-Assisted Birth: Findings from Provider Interviews in Kigoma, Tanzania

Abstract Background: Vacuum-assisted birth is not widely practiced in Tanzania but efforts to re-introduce the procedure suggest some success. Few studies have targeted childbirth attendants to learn how their perceptions of and experiences with the procedure affect practice.This study explores a largely rural cohort of health providers to determine associations between recent practice of the procedure and training, individual and contextual factors.Methods: A knowledge, attitudes and practice cross-sectional survey of 297 providers was conducted in 2019 at 3 hospitals and 12 health centers that provide comprehensive emergency obstetric care. We used descriptive statistics and binary logistic regression to model the probability of having performed a vacuum extraction in the last 3 months. Results: Providers were roughly split between working in maternity units in hospitals and health centers. They included: medical doctors, assistant medical officers (14%); clinical officers (10%); nurse officers, assistant nurse officers, registered nurses (32%); and enrolled nurses (44%). Eighty percent reported either pre-service, in-service vacuum extraction training or both, and 31% reported conducting a vacuum-assisted birth in the last 3 months. Based on 11 training and enabling factors, a positive linear association with recent practice was observed; the single most predictive factor was hands-on solo practice during in-service training (66%). The logistic model showed that for each additional training factor the likelihood of recent performance increased by 52% (OR 1.52, CI 1.327-1.740). A knowledge score based on indications and contra-indications for vacuum extraction showed an 11% increased probability for each item mentioned (OR 1.11, CI 1.033-1.196). Providers who worked in a health center compared to those in a hospital were 2.5 times more likely to have conducted a recent vacuum extraction (OR 2.46, CI 1.325-4.579), and male providers were twice as likely as females (OR 2.0, CI 1.088-3.733).Conclusions: Knowledge and training were positively associated with recent practice of vacuum extraction. Multiple training modalities appear to predict recent practice but hands-on experience during training may be the most critical component. We recommend a low-dose high frequency strategy to skills building with simulation and e-learning. A gender integrated approach to training may help ensure female trainees are exposed to critical training components.