Nurses and midwives during a training session at Kahama Hospital in Tanzania
In early May, the Tanzanian government discontinued all daily updates of COVID-19 infections and deaths, adopting a less restrictive approach to dealing with the virus.
At the time, 21 people had reportedly succumbed to the virus and more than 500 people had been infected. By the start of July, the government had declared the closure of 74 out of 85 designated COVID-19 facilities across the country, citing lack of patients.
While the government still enforces measures that discourage the spread of the virus such as social distancing, the wearing of face masks and placing a limit on crowds at social events, there is still a lack of information which leaves many health workers paranoid and vulnerable.
This is especially true for nurses and midwives who have to interact with diverse patients from different locations. That is why the Aga Khan University School of Nursing and Midwifery (AKU-SONAM) based in Tanzania has been carrying out a series of Continuous Professional Development (CPDs) training sessions, including one for maternity and child health professionals.
From July 7 through to July 10, 2020, Dr Kahabi Isangula, a senior instructor at AKU-SONAM and graduate of the Johns Hopkins Bloomberg School of Public Health held the first face-to-face training session at the Kahama Hospital for 22 nurses and midwives. Kahama is approximately 1,000 kilometres west of Dar es Salaam, close to the border with Burundi, another country that has adopted a less restrictive approach to handling the pandemic. The course was titled Maternal and new-born care in the context of COVID-19 and was based on guidelines from the World Health Organization (WHO) and the United Nations Population Fund (UNFPA).
“Nurses and midwives continue to be at the frontline fighting COVID-19 and form a critical aspect in response to disease outbreaks," explains Dr Kahabi “While they provide care to mothers and their babies in labour and delivery wards, nurses also serve as educators for the public and are crucial in disease prevention."
He added: “Most nurses in Kahama appeared to be unaware of how to offer maternal and new-born care during COVID-19 at the beginning of the training. They had so many misconceptions about how to handle the virus." This proved to be true as one of the enrolled nurses at Kahama Hospital, Nikiza Ndenzako, shared: “I didn't know that the risk of COVID-19 among pregnant women is the same as that of the general population."
The course enabled participants to understand how the virus is transmitted, those who face the highest risk, how to care for women with COVID and those without, how to reorganise antenatal services during COVID-19, separation of the mother and her baby, managing visitors, handling routine vaccinations as well as specific COVID-19 preventive measures in maternal and new-born care. Due to the tough economic climate, Kahabi's team also provided participants with some transport allowance, refreshments, free face masks during the four-day training session as well as hand sanitisers.
For the practical part of the course, participants were taken to the Kahama Hospital's Reproductive and Child Health clinic as well as to the labour and delivery facility to offer recommendations on how care could be improved to meet the COVID-19 preventive measures they had just learned.
Several aspects about whether the virus can be transmitted in the uterus from the mother to the baby are yet to be clarified through research. A few studies, however, suggest that since this is the case with other deadly viruses such as HIV and zika, this could be the case with COVID-19 too. However, Kahabi focused on sharing information on the transmission of the virus during labour and delivery as well as through breastfeeding. He urged the maternal and child health workers to be vigilant in separating the mothers and babies effectively, wearing personal protective equipment, patient isolation as well as maintaining a well-sanitised environment to ensure that droplets do not survive on surfaces.
Commenting on the course, enrolled nurse, Nikiza Ndenzako said: “Now I know that infection commonly occurs through droplets in the process of caring for the new-born, for example during breastfeeding. This should be done with protective gear such as face masks."
Another participant, Binti Mnyone, a nurse at the Isagehe Dispensary, reflected: “I had not received any training on how to offer maternal and new-born care during COVID-19 since the outbreak in Tanzania. But now, I can confidently offer care without fear because I gained a great deal of knowledge and skills through this training."
This was the first training session since the government enforced restrictions on public gatherings, so Kahabi and the CPD team had to be very strict about how many people they hosted. “We had to lock a few people out, but we promised to hold another one for them. We intend to train 60 nurses and midwives in Shinyanga and 60 in Kahama on maternal and child health," said Kahabi at the end of a rigorous four days.