P3.H150: Development of a Maternal Child Health Emergency Assessment Tool in the Kilimanjaro Region of Tanzania

Background: Maternal, neonatal, and pediatric deaths remain key global health challenges, especially in Low- and Middle-Income Countries (LMICs) like Tanzania. Many of these deaths occur in emergency settings and are related to lack of quality care. The World Health Organization’s Hospital Emergency Unit Assessment Tool (HEAT) has been used in Tanzania to assess the capacity of regional health centers to respond to emergencies. However, this tool was insufficient to assess capacity to respond to Maternal-Child Health (MCH) emergencies.

Methods: A team of United States and Tanzania based physicians conducted three multidisciplinary workshops with the Pediatric, Emergency, and Obstetrics and Gynecology departments at Kilimanjaro Christian Medical Centre using the nominal group technique. The original World Health Organization Health Emergency Assessment Tool was used as a guide to identify gaps in maternal and child emergencies and create a MCH specific tool to assess facility capacity to respond to MCH emergencies. As a follow up to the integrative workshops, we administered an acceptability, appropriateness, and feasibility survey to all 20 members of the workshops. This survey was distributed electronically with results collected in REDCap.

Results: We formulated a draft of the MCH HEAT based on real-time feedback from the workshops. There were 20 participants across all workshops. We sent a draft of the final modified MCH HEAT to all participants and incorporated another round of feedback remotely. The final MCH HEAT retained the four core sections of the original WHO HEAT: Facility Characteristics, Human Resources, Clinical Services, and Signal Function Performance. Examples of MCH specific measures within these categories, identified during the intervention development workshops, are shown in Table 1. In total, there were 20 measures assessed. We then constructed an acceptability, appropriateness, and feasibility survey. We received 12 total responses from the survey (response rate 60%). Four responses were from Pediatrics (three physicians and one nurse), five responses were from Emergency Medicine (three physicians and two nurses), and three responses were from Obstetrics and Gynecology (two physicians and one midwife). Within our multidisciplinary team of providers, 92-100% agreed or strongly agreed with the four measures of acceptability, 100% for all three measures of appropriateness, and 92-100% across the four measures of feasibility (Table 2).

Conclusion: A series of intervention workshops successfully generated a Maternal Child Health adaptation of the WHO HEAT. This adapted tool received positive feedback regarding acceptability, appropriateness, and feasibility. The next goal of this research program is to pilot the MCH HEAT at community medical centers in the Kilimanjaro region with the long-term aim to be able to replicate this tool universally in LMICs.